Bilateral Pedical Screw Instrumentation


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Please help. The doctor performed a pedical screw instrumentation L4 and L5 bilaterally, which we billed as 22840 as one segment but with an LT and RT because it was bilateral. We were paid for one, and denied on the second stating this is not paid bilaterally. Could we bill this as 22841 as an additional side or 22842, which would be more than one segment for reimbursement on the additional side. Please advise on the correct billing.

The operative report states as follows:

DX - Spinal Stenosis and Spondylolisthesis L4 and L5

Procedure- Pedical screw instrumentation L4 and L% bilaterally

Procedure Performed - ...We then proceeded with the pedical screw instrumentation. Began on the left side using a 4mm bur, decorticated the transverse process of L4 and L5, as well as the lateral aspect of the facet at L4-L5. Using an awl, we opened the superior aspect of the pedicle at L4, verified this using C-arm image intensification, placed the pedicle finder, pedicle probe down, and then placed a 6.5 x 50 mm screw in the L4 pedicle on the left. We then went to the L5 pedicle on the left. We opened the superior aspect pedicle with an awl and placed a probe and finder down and then placed a 6.5 x 45 screw in L5 at the left. Position of both the screws was checked by using C-arm image intensification. Once the screws were into the appropriate depth, a 40mm connecting rod was selected, placed, tightened, and appropriately torqued. We then moved over to the patient's right hand side, opened the pedicle at L4 on the right using an awl, followed that with the pedicle probe, pedicle finder and then placed a 6.5 x 50 mm screw at L4 on the right. Same procedure was done step-by-step at L5 on the right and a 6.5 x 45 mm screw was placed at L5 on the right. Once screw position was verified radiographically using C-arm image intensification, another connecting rod was placed, tightened, and torqued appropriately.

Thanks Again.