Neurosurgery Coding Alert

Question: How should I code if the surgeon places multiple instrumentation cages? What about threaded bone dowels?


Virginia Subscriber


Answer: The appropriate code to describe both synthetic cages and threaded bone dowels is +22851 (Application of intervertebral biomechanical device[s] [e.g., synthetic cage(s), threaded bone dowel(s), methylmethacrylate] to vertebral defect or interspace).

You should apply this code once per interspace. For instance, if the surgeon places two cages or three bone dowels at interspace T11/T12, you should report a single unit of 22851.

You may report additional units of 22851 for additional interspaces the surgeon treats. For instance, if the surgeon places two cages at T11/T12 and a third cage at T12/L1, you may report 22851 x 2.

For some payers, you may have to append modifier -59 (Distinct procedural service) to the second unit of 22851 to indicate that it represents instrumentation placed at a separate anatomic location.