Learn 5 Tips to Strengthen Your Spinal Fusion Coding
Find out how to recognize cage codes. Spinal fusion surgeries can be complicated to code, even for the most experienced orthopedic coders. Revenue Cycle Insider gathered together five helpful tips from Jennifer McNamara, CPC, CCS, CRC, CPMA, CDEO, CGSC, COPC, COSC, CEO of Healthcare Inspired, LLC, during her “Inside a Spinal Fusion” session at AAPC’s HEALTHCON 2025. Check out the following tips to boost your arthrodesis coding knowledge. Tip 1: Make Sure Documentation Shows Medical Necessity Orthopedic surgeons perform arthrodesis, or spinal fusion, for several different conditions, including spinal deformities. It’s critical to identify the condition being treated with the spinal fusion to show the medical necessity for the surgery. Below are some conditions McNamara mentioned that may be treated with arthrodesis: “Spinal stenosis is most common. It’s one of the main reasons you would do these procedures a lot of the time. Spondylolisthesis is another condition. I also see spinal fusions performed a lot with sciatica. And with some spinal fractures, you may have a procedure where at the same time as a fusion, the patient has a fracture repair,” McNamara explained. Tip 2: Define Segment vs. Interspace Coding Understanding the difference between segment and interspace is crucial to assigning the correct code for the procedure performed. McNamara admitted that she, like some of the attendees, also struggles to remember the distinction between the two terms. She encouraged everyone in the room and watching virtually to refer to the CPT® code book, as it provides a helpful breakdown of the body structures. According to the CPT® code book, a vertebral segment is a single division of the spine consisting of a vertebral bone, laminae, and articular processes. Whereas an interspace is the area between two vertebral portions, “which contains the intervertebral disc, and includes the nucleus pulposus, annulus fibrosus, and two cartilaginous endplates.” These codes blend different types of procedures together. When the surgeon operates on the interspace, which is the space between the vertebrae, the provider is focused on a different procedure than when they’re performing a laminectomy. “A segment isn’t just the vertebra itself, but rather a whole set of things that come together. You have your laminate, foramen, facet joints, and exiting nerve roots,” McNamara explained. “In a sense, you could look at it like an interspace, but it is very different as far as leveling goes.” The important thing to remember is that fusion codes are for interspaces and you’ll report segment procedures with laminectomy codes. Tip 3: Determine the Technique As stated above, the medical term for a spinal fusion is arthrodesis. The following CPT® codes are the regular fusion codes for the cervical, thoracic, and lumbar spine: These codes represent posterior or posterior lateral techniques, but 22610-22612 also include a lateral transverse technique if the provider uses that method. “The technique itself is how the surgeon is approaching the patient — this is key,” McNamara said. Codes 22600-22612 also cover a single interspace, so if the provider documents they operated on multiple levels or interspaces, the codes above cover one interspace. You’ll need additional codes to report work performed on the extra interspaces. Example: An orthopedic surgeon performs arthrodesis on the patient’s L1 through L4 interspaces using a posterolateral technique. You’ll report 22612 for the L1 space followed by three units of +22614 (… each additional interspace (List separately in addition to code for primary procedure)) to represent the work performed on the L2, L3, and L4 interspaces. Tip 4: Know How to Recognize Instrumentation Codes You’ll determine the correct instrumentation code for the arthrodesis procedure based on the technique and the number of segments operated on. Posterior instrumentation codes include: Anterior instrumentation codes include: Interbody devices: Interbody devices, also known as cages or implants, are apparatuses inserted during surgery to aid in healing. The CPT® code descriptors include language that allow you to easily locate the correct interbody device code if the piece is used. For example, +22853 (Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure)) includes “with integral anterior instrumentation,” which includes the work covered by +22845, +22846, and +22847. Therefore, you won’t report +22853 and +22845, +22846, or +22847 together. Modifier 59: You should only apply modifier 59 (Distinct procedural service) to a fusion code if the documentation proves that the anterior instrumentation was not integral to the device because the instrumentation is already included in the descriptor for +22853. Some devices arrive with the plate and screws connected, and the physician needs to insert the screws. However, sometimes the provider needs to add more hardware, and they’ll need to document this information. McNamara also stated that she will confirm how the device is delivered to understand how to code the procedure. “Give me the model, give me the name of the device in the op note because then I can look it up and I can tell how it comes,” she said. Tip 5: Examine the Codes That Combine Fusion Procedures The surgeon may choose to use an implant during the surgery to provide stability, encourage fusion, and aid in spinal alignment. When that happens, you’ll need to look for certain wording in the code descriptors to locate the correct code for the fusion procedure. Using a posterior lumbar fusion (PLF) as an example, 22612 is the procedure code without a cage while 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace, lumbar) represents the procedure performed with a cage placed. Now, if the surgeon combines a posterior or posterolateral technique with a posterior interbody technique, then you’ll report a combination code. In this example, you’d use 22633 (Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace, lumbar) to report the procedure. The “posterior interbody technique” represents 22630 and “posterior or posterolateral technique” represents 22612. Add-on codes: Also, remember to use an appropriate add-on code, such as +22634 (… each additional interspace (List separately in addition to code for primary procedure)), to report the additional interspaces operated on during the procedure. Mike Shaughnessy, BA, CPC, Development Editor, AAPC
