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Orthopedic Coding Alert

Reader Question:

Keep Removal and Reinsertion off Same Claim

Published on Thu Jan 24, 2008

Question: If the surgeon removes instrumentation, performs a revision spine procedure, and places new pedicle screws at the same level, may I report removal (22852) and reinsertion (22849)?
Kansas Subscriber Answer: No, you should not report these codes together. CPT guidelines for spinal instrumentation specify that -22849 should not be reported with 22850, 22852, and 22855 at the same spinal levels.- And according to Correct Coding Initiative (CCI) edits, 22849 (Reinsertion of spinal fixation device) includes 22852 (Removal of posterior segmental instrumentation). Reason: Code 22849 specifies -reinsertion.- You can't reinsert a device without having removed a previously inserted device. Therefore removal (22852) is integral to reinsertion (22849), and you should report only 22849 when the surgeon performs both at the same level.
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