Neurosurgery Coding Alert

Question: Our patient previously (in the past six months) had direct lateral interbody fusion utilizing medtronics system with intervertebral cage placement with bone graft. The patient recently returned, stating he had a fall and the MRI impression stated intervertebral cage had displaced. Our physician took the patient back to OR and removed the extruded cage and replaced a with larger cage with new bone graft and placed buttress plate using the direct lateral approach.

Would this be considered a refusion, and in that case, do we report both 22558 and 22851? Or would we only report 22851?

New York Subscriber

Answer: Since this procedure is being repeated outside of the 90 day global period, one would report 22558 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression]; lumbar) for the approach and revision of the lateral lumbar interbody arthrodesis, Although one can report 22851 (Application of intervertebral biomechanical device[s] [e.g., synthetic cage(s), methylmethacrylate] to vertebral defect or interspace [List separately in addition to code for primary procedure]) for the revision of the interbody cage, this would best be described with 22849 (Reinsertion of spinal fixation device) for reinsertion of a spinal fixation device. Unless the lateral buttress plate attaches to both adjacent vertebrae (which would be described as 22845 [Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure)]), the typical buttress plate attached to one vertebra is reported with the unlisted code 22899 (Unlisted procedure, spine).