Neurosurgery Coding Alert

Question: Our surgeon removed anterior instrumentation and reconstructed the lumbar spine using arthrodesis and prosthetic insertion. How can I code this?


Washington Subscriber Answer: Report each procedure as performed:


22855 - Removal of anterior instrumentation

22558 - Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace (other than for decompression); lumbar

22851 - Application of intervertebral biomechanical device(s) (e.g., synthetic cage[s], threaded bone dowel[s], methylmethacrylate) to vertebral defect or interspace. In the past, the National Correct Coding Initiative listed 22558 (arthrodesis) as mutually exclusive of 22855 (instrumentation removal), thereby implying (incorrectly) that a surgeon wouldn't or couldn't remove a spinal fusion and reconstruct it during the same session.
 
More recently, the NCCI has reclassified this edit as "inactive" and, therefore, payers should honor claims for 22558 and 22855 during the same session.

If your payer denies the claim, be sure to appeal, citing the NCCI edit's inactive status and your documentation as evidence that the claim is legitimate. Clinical and coding expertise for You Be the Coder and Reader Questions provided by Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University Department of Surgery.