Orthopedic Coding Alert

Nail down location and instrumentation type to keep your coding on the straight and narrow
If your surgeon uses spinal instrumentation, you don't have to get used to diminished reimbursement. Once you know which services are included in the surgery and what type of instrumentation your surgeon used, you-ll know when you can collect and when the service is bundled.

When your surgeon inserts spinal instrumentation, you should first determine which type of device he used. CPT includes 10 codes for inserting spinal instrumentation:

- 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)

- 22841 -- Internal spinal fixation by wiring of spinous processes

- 22842 -- Posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and sublaminal wires); 3 to 6 vertebral segments

- 22843 -- Posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and sublaminal wires); 7 to 12 vertebral segments

- 22844 -- Posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and sublaminal wires); 13 or more vertebral segments

- 22845 -- Anterior instrumentation; 2 to 3 vertebral segments

- 22846 -- Anterior instrumentation; 4 to 7 vertebral segments

- 22847 -- Anterior instrumentation; 8 or more vertebral segments

- 22848 -- Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum

- 22851 -- Application of intervertebral biomechanical device(s) (e.g., synthetic cage[s], threaded bone dowel[s], methylmethacrylate) to vertebral defect or interspace. Keep in mind: CPT codes differentiate between posterior instrumentation (22840, 22842-22844) and anterior instrumentation (22845-22847).

Guidance: Generally, the instrumentation type corresponds to the surgical approach (anterior or posterior). If the surgeon places posterior instrumentation, you must further determine if the device is segmental (22842-22844) or nonsegmental (22840).

The surest way to do this is to count the number of fixation points. -If instrumentation attaches to only two vertebral segments, regardless of the span, the instrumentation is considered non-segmental,- says Gregory Przybyl-ski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, N.J. -If the instrumentation attaches to three or more vertebral segments, the instrumentation is considered segmental.-

In some cases, the surgeon places a metal cage or other prosthetic device for stabilization in an area where he removed a large portion of the vertebra. This represents a third type of instrumentation, which you should report using 22851. Report only a single unit of 22851, regardless of how many devices the surgeon places at one level. But if the surgeon places devices on multiple spinal levels, you may report multiple units of 22851 (one unit for each individual spinal level). Example 1: The surgeon places two cages at level T6-T7.

Solution 1: Report [...]