View Associated Notes
Category 3 - THERAPEUTIC PROCEDURES
51026 - Additional Information
Fixation of motion segment with vertebral body screw, pedicle screw or hook instrumentation including sublaminar tapes or wires, more than 12 motion segments, excluding vertebral body tethering for the treatment of scoliosis and not being a service associated with a service to which item 51020, 51021, 51022, 51023, 51024 or 51025 applies (H)
(Anaes.) (Assist.)
Fee: $3,192.05 Benefit: 75% = $2,394.05
(See para TN.8.141, TN.8.143 of explanatory notes to this Category)
Associated Notes
Category 3 - THERAPEUTIC PROCEDURES
TN.8.141
Application of items 51011 to 51171 (Sub-group 17)
Spinal surgery items 51011 to 51171 cannot be performed in conjunction with any other item (outside of subgroup 17) in Group T8 of the MBS (surgical operation items 30001 to 50952), when that surgical item is related to spinal surgery. Items 50600 to 50644 - spine surgery for scoliosis and kyphosis in paediatric patients - are excepted from this rule when claimed in conjunction with items 51113 and 51114.
Meaning of Motion Segment
Motion segment is defined as including all anatomical structures (including traversing and exiting nerve roots) between and including the top of the pedicle above to the bottom of the pedicle below.
Combined Anterior and Posterior Surgery
Combined anterior/ posterior surgery items 51061, 51062, 51063, 51064, 51065 and 51066 cannot be claimed with any item between 51020 and 51045 (i.e. items for spinal instrumentation, posterior bone graft and/or anterior column fusion).
Spinal instrumentation
Spinal instrumentation items 51021 to 51026 cannot be claimed for vertebral body tethering for the treatment of scoliosis. Medicare benefits are not payable for this procedure.
Full clinical details should be documented in the patient notes, including the number of motion segments fused, which demonstrates the clinical need for the service, as this may be subject to audit.
Interpretation of Lumbar Spinal Fusion
Lumbar spinal fusion may not be claimed for chronic low back pain for which a diagnosis has not been made.
Related Items: 51011 51012 51013 51014 51015 51020 51021 51022 51023 51024 51025 51026 51031 51032 51033 51034 51035 51036 51041 51042 51043 51044 51045 51051 51052 51053 51054 51055 51056 51057 51058 51059 51061 51062 51063 51064 51065 51066 51071 51072 51073 51102 51103 51110 51111 51112 51113 51114 51115 51120 51130 51131 51140 51141 51145 51150 51160 51165 51170 51171
Category 3 - THERAPEUTIC PROCEDURES
TN.8.143
Spinal Instrumentation (cervical, thoracic and lumbar) - Items 51020 to 51026
Items 51020 to 51026 are intended for spinal instrumentation at any level. The appropriate item is determined by the number of motion segments instrumented, barring item 51020 which applies to one vertebra.
The use of items (51021 to 51026) excludes vertebral body tethering for the treatment of scoliosis.
Full clinical details should be documented in the patient notes, including the number of motion segments fused, which demonstrates the clinical need for the service, as this may be subject to audit.
For posterolateral spinal fusion with instrumentation, two item numbers are selected: one from 51020 to 51026 and one from 51031 to 51036. If decompression is also performed, three items are selected: one from 51011 to 51015, one from 51020 to 51026 and one from 51031 to 51036.
For instrumented spinal fusion with interbody and posterolateral bone graft (with or without cages) and decompression, four item numbers are selected: one from one from 51011 to 51015, one from 51020 to 51026, one from 51031 to 51036 and one from 51041 to 51045.
Legend
- Assist - Addition/Deletion of (Assist.)
- Amend - Amended Description
- Anaes - Anaesthetic Values Amended
- Emsn - EMSN Change
- Fee - Fee Amended
- Renum - Item Number Change (renumbered)
- New - New Item
- NewMin - New Item (previous Ministerial Determination)
- Qfe - QFE Change