Neurosurgery Coding Alert

Question: Our surgeon does a T10-L2 posterior lumbar fusion in addition to open vertebroplasty at T10 and L2. Please advise how to report this. We are reporting diagnosis codes 737.10 (Kyphosis [acquired] [postural]) for acquired Kyphosis and 733.13 (Pathological fracture of vertebrae) for pathologic fracture.

Ohio Subscriber

Answer: Assuming that a posterolateral rather than posterior interbody fusion is performed, the choice of the primary stand-alone code is up to the provider. Since the lumbar posterolateral fusion code is valued higher than the comparable thoracic code, one would report 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar [with lateral transverse technique, when performed]) for the L1-L2 posterior arthrodesis and 3 units of 22614 (Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment [List separately in addition to code for primary procedure]) for the T12-L1, T11-T12, and T10-T11 posterior arthrodesis.

Since thoracic vertebroplasty is valued higher than lumbar vertebroplasty, you would report 22520 (Percutaneous vertebroplasty [bone biopsy included when performed], 1 vertebral body, unilateral or bilateral injection; thoracic) with 51 (Multiple procedures...) for the T10 vertebroplasty and 22522 (Percutaneous vertebroplasty [bone biopsy included when performed], 1 vertebral body, unilateral or bilateral injection; each additional thoracic or lumbar vertebral body [List separately in addition to code for primary procedure]) for the L2 vertebroplasty.

Although the vertebroplasty codes describe a percutaneous procedure, the technique and physician work are similar when performing this in conjunction with an open procedure. Although not specified in the vignette, other separately reportable procedures than may have been performed include bone graft harvest and spinal instrumentation.