Orthopedic Coding Alert

Question: What code should I use for the removal of a PEEK cage? The surgeon isn't reinserting it, but is placing a structural graft in its place.

Texas Subscriber

Answer: A PEEK cage is an interbody fusion cage made from polyetheretherketone (or PEEK) rather than titanium, as with most such cages. To report its removal, you-ll most likely rely on 22855 (Removal of anterior instrumentation).

For the structural graft, you-ll have to pick from two codes:

- 20931 -- Allograft for spine surgery only; structural

- 20938 -- Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision).

You-ll use 20938 if your surgeon uses bone from the patient's body for the graft, and rely on 20931 if the physician uses graft material from another source, such cadaverous bone.

In addition, because the orthopedist is removing the instrumentation and inserting a structural allograft, he's also performing a revision arthrodesis. You-ll report this with either 22554 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression]; cervical below C2) or 23558 (- lumbar), depending on whether he performed the surgery on the cervical or lumbar spine.

Reader Questions and You Be the Coder were reviewed by Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network LLC; and Bill Mallon, MD, orthopedic surgeon and medical director at Triangle Orthopaedic Associates in Durham, N.C.