Neurosurgery Coding Alert

Question: Patient had anterior cervical discectomy and fusion (ACDF) at C4-6 and had previously placed hardware removed from C6-7. We billed both 22845 (Anterior instrumentation; 2 to 3 vertebral segments [List separately in addition to code for primary procedure])-59 (Distinct procedural service) and 22855 (Removal of anterior instrumentation). We received denial for 22845 as it is as bundled with 22855. Was it incorrect to bill for the hardware removal at C6-7 and the placement of new at C4-6?Ohio SubscriberAnswer: While in some circumstances, removal and placement of an anterior spinal fixation device are considered bundled services, your example describes removing a plate from one interspace location (C6-C7) and placing a new larger plate at a separate anatomical site (C4-C6). You may report both codes, appending the 59 modifier to 22855 to reflect the separate anatomical site.