Wiki Counting Segments for Spinal Instrumentation

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mhstrauss

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We have a little discussion going in my office regarding the correct way to count segments for segmental instrumentation (22842, 22843).
Example: Surgeon placed lateral mass screws bilaterally at C4, C5, C6. C7 and T1 were not instrumented due to compression deformity. Screws placed bilaterally at T2. Skipped T3 due to compression fracture. Screws placed bilat at T4. Skipped T5 due to deformity. Screws placed bilat at T6. Rods were then bent to accommodate the cervicothoracic curve and placed from C4 through T6. The question is, do you count only the segments at which screws were placed? In this example, that would be 6 segments—C4, C5, C6, T2, T4, T6, which equals a 22842. Or do you count the total segments spanned? That is 10 here, which is 22843. I'm leaning towards 22842, based on the logic of choosing segmental versus nonsegmental instrumentation---the segment is not counted if screws are not affixed.

Appreciate any guidance or resources anyone can give!! :D
 
I'm leaning toward 22843 because even though screws were not placed at certain segments the rods are spanning those segments. We just had this discussion in our office the other day.
I'm fairly new to neurosurgery only been coded for 9mos.
 
CTReinhardt

The CPT defines "Segmental Instrumentation" as "fixation at each end of the construct and at least ONE additional interposed bony attachement." Since fixation (screws) are only required on the ends and once in between each end, you should count each segment between your end attachement.- CPT 22843
 
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