Wiki Conflicting information

[lodawnyoung]

I am getting conflicting information on the instrument codes 22845 and 22846. The office manager that I took over coding for is saying that I should count the vertebra involved
ie; L2-L3, L3-L4, L4-L5 would equal a 22846 for L2, L3, L4, L5. My PA/Coding auditor is saying that I need to count the interspaces involved because the reason for the plate is to stabilize the interspaces. So the above scenario would equal a 22845 for the three interspaces. Could someone please weigh in on this? I tend to agree with counting the interspaces. Thanks so much!

 

[OCD_coder]

The CPT book is your guide, only. Instrumentation is by segments, meaning each bone segment not interspaces. The AAOS is a good source for information. Be wary of information that contradicts CPT information regardless of the source.

Source: http://www.aaos.org/news/aaosnow/aug08/managing2.asp
Instrumentation
The third key component is instrumentation. Instrumentation codes are selected based on the number of segments spanned, the approach (anterior or posterior), or pelvic fixation. In 2008, the status of instrumentation codes was changed from modifier 51 exempt codes to add-on codes. Refer to the AMA CPT Manual for a full listing of primary procedures (CPT codes) to which instrumentation codes may be added. Table 3 shows instrumentation codes.

For example, an anterior cervical plate placed from C3-C5 would be coded 22845; one placed from C3-C7 would be coded 22846. Code 22847 would be used for an anterior rod placed from T2-T10.

Posterior instrumentation codes are defined as segmental and nonsegmental. Nonsegmental instrumentation means that the construct has only two points of attachment; segmental instrumentation means that at least three points of attachment are used.

For example, the surgeon places pedicle screws bilaterally at L2 and L4 and then inserts a rod. Because there are only two points of attachment, this is considered nonsegmental instrumentation, even though the rod spans three vertebrae. If, however, the surgeon placed pedicle screws bilaterally at L2, L3, and L4 and then inserts a rod, the procedures would be considered segmental instrumentation.

Instrumentation code 22841 covers internal spinal fixation by wiring of the spinous processes and may not be reported with other instrumentation CPT codes. The code for pelvic fixation (22848), however, may be reported in addition to other instrumentation codes. Cages may be reported one time per interspace