Orthopedic Coding Alert

Question: How do you code when the surgeon did corpectomies at C4 and C5, fusion(s) from C3-C6, used PEEK (polyetheretherketone) cage and 30 mm screws? The surgeon used three separate, stackable, PEEK cages to fill the space.

Ohio Subscriber

Answer: Cages are reported per level not per cage. In this case, the surgeon has fused across 3 levels - C3-4, C4-5, C5- 6 and used three cages, so you would report code 22851 (Application of intervertebral biomechanical device[s] [eg, synthetic cage[s], methylmethacrylate] to vertebral defect or interspace [List separately in addition to code for primary procedure])x3.

You also report 63081 (Vertebral corpectomy [vertebral body resection], partial or complete, anterior approach with decompression of spinal cord and/or nerve root[s]; cervical, single segment) and 63082 (Vertebral  corpectomy [vertebral body resection], partial or complete, anterior approach with decompression of spinal cord and/or nerve root[s]; cervical, each additional segment [List separately in addition to code for primary procedure]) for the corpectomies, assuming that more than half of the vertebral body was removed.

Codes 22554 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression]; cervical below C2) with modifier -51 (Multiple procedures:.....) and 22585 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression]; each additional interspace [List separately in addition to code for primary procedure])x2 are for the fusions C3-C6. You may additionally report any instrumentation performed.

If a plate and screws were placed spanning from C3 to C6, you would also report code 22846 (Anterior instrumentation; 4 to 7 vertebral segments [List separately in addition to code for primary procedure]).

You also report the bone graft. More often than not, spine surgeons use locally harvested autograft bone from the corpectomy and you code 20936 (Autograft for spine surgery only [includes harvesting the graft]; local [eg, ribs, spinous process, or laminar fragments] obtained from same incision [List separately in addition to code for primary procedure]).

If the surgeon uses bone morphogenic protein, you code 20930 (Allograft, morselized, or placement of osteopromotive material, for spine surgery only [List separately in addition to code for primary procedure]). Others fill the cage with some type of synthetic graft combined with bone marrow aspirate harvested from the patient which is usually from the iliac crest. In this case, you report 38220 (Bone marrow; aspiration only).