Neurosurgery Coding Alert

Question: Why does the fee schedule assign no relative value units (RVUs) to 22841? Should I charge for it? Indiana Subscriber Answer: Previously, CPT descriptors for spinal arthrodesis codes specified "including internal fixation." With the revision of these code descriptors several years ago, CPT eliminated this wording and created 22841 (Internal spinal fixation by wiring of spinous processes) to report internal fixation separately. However, the CMS fee schedule did not adjust the value of the arthrodesis codes downward (to reflect the absence of internal fixation) and continued to consider 22841 an integral component of arthrodesis with no separate fee (note that the Medicare Physician Fee Schedule assigns a status code "B" bundled into payment for other services not specified to 22841). You may report 22841 for coding accuracy, but Medicare will not reimburse. The physician should develop a fee for this procedure, because some third-party payers will pay. Ask your payer for guidelines.