Neurosurgery Coding Alert

Question: Our neurosurgeon recently performed a posterior lumbar interbody fusion (PLIF) on three interspaces. During the encounter, he also stabilized the spine with a bone graft. How many codes should I report for this encounter?

Kentucky Subscriber

Answer: You-ll report three codes for the PLIF and one for the bone graft:

- report 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace [other than for decompression], single interspace; lumbar) for the PLIF on the patient's initial interspace.

- report +22362 (... each additional interspace [list separately in addition to code for primary procedure]) x 2 for PLIF on the second and third interspaces.

- report the appropriate bone graft code according to the surgeon's notes. He may perform any graft from the 20930-20938 series during a PLIF session, so check the notes carefully before choosing a bone graft code. But in most PLIF encounters, the neurosurgeon will perform a structural allograft (20931, Allograft for spine surgery only; structural) or a structural autograft (20938, Autograft for spine surgery only [includes harvesting the graft]; structural, bicortical or tricortical [through separate skin or fascial incision]).

Pedicle screws? During some PLIF encounters, the neurosurgeon needs to perform pedicle screw fixation. When this occurs at a single interspace or multiple interspaces with only two fixation points, report 22840 (Posterior nonsegmental instrumentation [e.g., Harrington rod technique, pedicle fixation across one interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation]).

When the surgeon attaches pedicle screws at more than two fixation points, use codes 22842 (Posterior segmental instrumentation [e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires]; 3 to 6 vertebral segments), 22843 (... 7 to 12 vertebral segments) or 22844 (... 13 or more vertebral segments) depending on  the number.