Neurosurgery Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: A neurosurgeon performs a procedure including a posterior lumbar fusion with instrumentation across one interspace, L3-L4, using TSRH pedicle screw fixation. This is coded as 22840. CPT 2001 does not describe this procedure as bilateral or unilateral or as dual rod versus single rod. If the neurosurgeon places screws and rods on both left and right pedicles of L3 and L4, how should I code?

California Subscriber


Answer: Code 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) should be billed for two fixators and a connector that may span two vertebral segments, whether unilateral or bilateral. Code 22842 (posterior segmental instrumentation [e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires]; 3 to 6 vertebral segments) would be appropriate only if the instrumentation extended to three or more segments. Just as you should not code twice for two cages at the same interspace, it is incorrect to code twice or to use modifier -50 (bilateral procedure) for performing this procedure.