intervertebral device revision

tdiederich

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Please help. Our spine doctor is taking a patient back into surgery after he had undergone a TLIf at L4-L5 as well as a posterior spinal fusion with instrumentation, L4-L5. The patient experienced migration of his cage postoperatively with increased lumbar-based pain. He returned to the OR for a revision of his anterior cage one month after his initial surgery. How do you code a revision? Here is part of the OP report.

I removed the rods, placed distraction around the left side and was capable of removing the cage from the L4-L5 interspace. I upsized the cage and packed this with new bone morphogenetic protein. We inserted in the spacing and pressed. We were quite happy with the position of the cage. We compressed significantly posterior aspect of the spine to receate lordosis and also prevent posterior cage migration. I was very happy with the cage position and the instrumentation. I replaced the BNP with mesh graft matrix in the facet and lateral gutters.

Procedure performed:
Removal of anterior intervertebral device, L4-L5
Application of intervertebral biomechanical device, L4-L5

Any help would be greatly appreciated. Thanks!
 

sllindsey

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I would bill the 22850 and 22851. there are no bundling issues with these two codes. Dont forget the 78 modifier!
 

RebeccaWoodward*

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Tisha,

You are correct...22851 could not be reported with 22850. Although I have not had this exact scenerio, I'll take a stab.

What about 22849? Yes...he did remove and reinsert but you can't charge for both, for the same level. Your thoughts? Anyone else?
 
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