Billing and Coding: Cervical Fusion

Coverage for cervical fusion is limited to cervical spine fusion procedures and is allowable only when the procedure meets the reasonable and necessary clinical and frequency criteria in the applicable draft LCD Cervical Fusion. Claims require valid ICD-10-CM diagnosis coding, complete and legible documentation (including operative notes, provider signatures, and evidence of medical necessity), and adherence to coding edits (NCCI/OPPS); inclusion of non–FDA approved biological injectants (e.g., amniotic/placenta-derived products, PRP) will result in denial of the entire claim.

"Cervical fusion and related cervical spine fusion procedures are the only procedures covered under this policy; other joint or non-cervical spinal procedures (e."

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