Neurosurgery Coding Alert

Question: Below are details of a procedure our surgeon did.

"The spine was exposed and the soft tissues were cleaned up. Some more x-rays were taken to verify T9 vertebral body position. The T9 vertebral body was noted to be completely disintegrated and soft. In piecemeal fashion, using sharp curettes and rongeurs as well as curettes, the bone was completely removed. All the bone as well as discs between T9 and T10 as well as T9 and T8 had been completely removed and the anterior longitudinal ligament was exposed. There was no empyema left and no pus was seen at any time. Then expandable cage was placed in the disc space and expanded. This cage had an official size from 22-30 mm, and it was mostly expanded almost to its maximum height. Continuous neuromonitoring was done. When cage placement was verified, the staples were applied to T8 and T7 vertebral bodies and screws were placed through the staples. Singular staples were placed in the T10 vertebral body, trying to avoid existing pedicle screws, placing the screws in lower end of the vertebral body in the endplate neighborhood."Can you please opine if we use 22851 (Application of intervertebral biomechanical device[s] [e.g., synthetic cage[s], methylmethacrylate] to vertebral defect or interspace [List separately in addition to code for primary procedure]) one time or 3 times in this procedure?

Arizona Subscriber

Answer: Code 22851 is used once for every intervertebral defect in which a prosthetic device is placed. Since the scenario describes a single defect between the T8 and T10 vertebral bodies (after resection of the T9 vertebral body and adjacent T89 and T910 discs), a single use of 22851 properly reflects the placement of the single interbody expandable cage.