Wiki Help with replacement of interbody spacer

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hacarrico

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Lately I've had a few cases where the surgeon did a revision posterior interbody fusion (22630) and removed or replaced an interbody spacer.

In the case the spacer is replaced, I'm wondering whether to code 22630 and 22851 (billing for the new spacer, but not the removal of the old one) or bill 22630 and 22849-51. I'm not sure whether the spacer is considered a "spinal fixation device."

In the case that the spacer was removed, but not replaced, is it billable at all or bundled with the fusion? If billable, I'm having difficult locating a code that's appropriate for the removal of this device.

Thanks for any help!
 
We have always been told to bill spacer's as 20931. With that being said, is he truly using a spacer or a cage? Cage would be 22851. However, there is no separate code for removal of an intervertebral device and if he is not replacing the graft with anything, I dont know that I would really bill a fusion. It sounds more like an exploration of fusion which would be 22830 only. If he does replace with a spacer, I would probably bill for the fusion and the instrumentation code as a refusion which would be 22630 and 20931 for the spacer. Hope this helps!
 
It really is a cage. I'm leaning toward billing 22851 when it is replaced, and not billing for a straight removal at all. Thanks for your input!
 
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