Neurosurgery Coding Alert

" Coding for placement of spinal instrumentation can be complicated by several factors, including the need to identify properly the type of instrumentation and the number of spinal levels spanned. And, instrumentation is often placed during a procedure in which two surgeons work together, complicating documentation and coding requirements. Last, coders must know how to report removal of instrumentation and/or postsurgical complications. Determine Location First Instrumentation may consist of rods, cages, plates, wires and/or other mechanical devices. When you choose CPT code(s) to report a procedure, however, the location of the instrumentation rather than the type is the most important selection criteria. Instrumentation may be either anterior (attaching to the front portion of the spine or vertebral segment) or posterior (attaching to the back of the spine or vertebral segment). Posterior instrumentation, which is more common, may be further classified as segmental or nonsegmental. Note: Generally, the surgical approach (anterior or posterior) will correspond to the location of the instrumentation. Nonsegmental posterior instrumentation attaches to the spine at two points only the proximal and distal portions (top and bottom) of the rod or other device with no attachment to any vertebra between those points. For example, a rod spanning from the first to fifth lumbar levels is attached to the spine at L1 and L5 but would not be attached at L2, L3 or L4. Placement of nonsegmental posterior instrumentation is reported using 22840 (Posterior non-segmental instrumentation [e.g., Harrington rod technique, pedicle fixation across one interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation.)

Segmental posterior instrumentation attaches to the spine at three or more points, including the proximal and distal portions of the rod or other device. For instance, a rod spanning from the third cervical to third thoracic vertebra is attached at C3 and T3 but is also attached to at least one other interspace between those two points (e.g., C6/C7). Placement of segmental posterior instrumentation is described using 22842 (Posterior segmental instrumentation [e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires]; 3 to 6 vertebral segments), 22843 ( 7 to 12 vertebral segments) and 22844 ( 13 or more vertebral segments) as determined by the number of vertebral segments spanned. Note: Instrumentation procedures are reported according to the number of interspaces (i.e., the spaces between vertebral segments, such as L1/L2) spanned, while fusion is reported according to the number of segments (i.e., vertebral segments, such as L1, L2) spanned. Code 22848 (Pelvic fixation [attachment of caudal end of instrumentation to pelvic bony structures] other than sacrum) is used to describe fixation of the distal (caudal literally closer to the tailbone"") portion of posterior instrumentation (segmental or nonsegmental) to the pelvis for instance" [...]