Code Spinal instrumentation in 4 steps
Take a walk through procedural devices, vertebral segments, and spacing, while dodging certain modifiers.
Coding for spinal instrumentation is quick and easy, with only a few basic steps to follow.
Step 1: Determine if the
Instrumentation Crosses Spinal Levels
Spinal instrumentation comes in two basic varieties: devices placed within the intervertebral space (that is, the instrumentation is placed between two vertebral segments) or confined to a single vertebral segment, and devices placed across two or more vertebral segments.
If the surgeon places a prosthetic device — typically made of titanium or polyether ether ketone (PEEK) — in the intervertebral space or to a single vertebral segment for repair of a vertebral defect, report add-on code +22851 Application of intervertebral biomechanical device(s) (eg, synthetic cage(s), threaded bone dowel(s), methylmethacrylate) to vertebral defect or interspace (List separately in addition to code for primary procedure).
Report a single unit of +22851 regardless of how many devices the surgeon places at a single level. If the surgeon places devices on multiple spinal levels, you may report multiple units of +22851 (one unit for each individual spinal level), appending modifier 59 Distinct procedural service to the second and subsequent units. For instance, report a single unit of +22851 for two small PEEK devices placed at L4/L5. For a single PEEK device at L4/L5 and a second PEEK device at L3/L4, report 22851, 22851-59.
Step 2: If the Levels Cross,
Determine Anterior or Posterior Placement
When coding for instrumentation that spans several vertebral segments using rods, cages, plates, wires, and/or other mechanical devices, determine whether the device is anterior (attached to the front of the spine or vertebral segment, toward the front of the body) or posterior (attached to the back of the spine or vertebral segment, facing rearward).
Depending on the number of vertebral segments spanned, report anterior instrumentation using:
- +22845 Anterior instrumentation; 2 to 3 vertebral segments;
- +22846 Anterior instrumentation; 4 to 7 vertebral segments; or
- +22847 Anterior instrumentation; 8 or more vertebral segments.
When counting vertebral segments, be mindful that a single interspace sits between two vertebral segments. For instance, the span C6-T2 contains four vertebral segments (C6, C7, T1, and T2) and three vertebral interspaces (C6/C7, C7/T1, and T1/T2). CPT® +22846, which describes four to seven vertebral segments, reports anterior instrumentation across this span.
Step 3: If Posterior, Determine
Segmental or Non-segmental
If the surgeon places posterior instrumentation, you must determine whether the device is segmental or non-segmental.
Non-segmental posterior instrumentation attaches to the spine at two points only (e.g., a rod spanning from the first to fifth lumbar levels, attached to the spine at L1 and L5, with no attachments at L2, L3, or L4). Report placement of non-segmental posterior instrumentation using +22840 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across one interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation (List separately in addition to code for primary procedure).
Segmental posterior instrumentation attaches to the spine at three or more points, including the proximal and distal portions of the rod or other device. Report placement of segmental posterior instrumentation, depending on the number of vertebral segments spanned, using:
- +22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires);
3 to 6 vertebral segments;
- +22843 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires);
7 to 12 vertebral segments); or
- +22844 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 13 or more vertebral segments.
Step 4: Modifiers 50, 51, and 62 Don’t Apply
CPT® defines spinal instrumentation procedures as inherently bilateral; therefore, never use modifier 50 Bilateral procedure with any of these codes.
Additionally, as all spinal instrumentation codes are add-on codes, they are not to be reported with modifier 51 Multiple procedures, and they are exempt from multiple procedure payment reductions.
Lastly, CPT® guidelines prohibit the reporting spinal instrumentation codes with modifier 62 Two surgeons.
|spanning 2 to 3 segments||22845|
|spanning 4 to 7 segments||22846|
|spanning 8 or more segments||22847|
|segmental||spanning 3 to 6 segments||22842|
|spanning 7 to 12 segments||22843|
|spanning 13 or more segments||22844|
|cage, threaded bone dowel, methylmethacrylate, etc.|