Neurosurgery Coding Alert

Question: When coding for a posterior cervical or lumbar fusion of just two vertebrae, how many codes should be used for the arthrodesis? For instance, the posterior cervical fusion code is 22600, which states -arthrodesis, posterior or posterolateral technique, single level.- Would it be appropriate to add 22614 or -each additional vertebral segment- since 22600 (and 22610 and 22612) refer to -single levels-?


Florida Subscriber


Answer: You should claim one fewer arthrodesis code than segments fused, because this is the number of levels (interspaces) fused.

If your neurosurgeon performs a fusion of three segments (C6/C7/T1), report 22600 (Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment) for C6/C7, with +22614 (- each additional vertebral segment [list separately in addition to code for primary procedure]) for the fusion of C7/T1. Alternatively, you may report the thoracic (C7/T1) fusion first using 22610 (- thoracic [with or without lateral transverse technique]) and also claim 22614 for the C6/C7 fusion. Either method accurately describes the procedures performed, and payment is nearly identical.

The descriptors for 22600-22614 can be confusing because they refer to spinal -levels- rather than spinal -interspaces,- but for coding purposes these have the same meaning. Arthrodesis implies a fusion of a motion segment, however, and a motion segment refers to two adjacent vertebrae and the intercalary disk (in other words, two segments and the interspace between them).

But do not report 22600 and 22610 together: Payers will consider this double-billing because you will be charging twice for the approach, closure and postoperative management. Choose one primary procedure code for the first fusion (either 22600 or 22610) and report add-on code 22614 for each additional segment.