Wiki Removal spinous process disctractor

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nan.coder

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Physician performed Removal hardware L2-3 (posterior spinous process distractor 0171T when placed), Redo laminotomy L2-3 with removal recurrent disc herniation & Posterior fusion L2-3 with non-segmental fixation (CoFlex device). My inclination is not to bill the hardware removal because replacing with CoFlex non-segmental fixation at same level. Of course, physician states they are difference devices.

Any comments?

Thank you.
 
Removal spinous process distractor

Theso13,
I have looked at this situation since these devices came on the market, and unfortunately, there is no code for removal of the spinous process distractor. I have seen many of these implanted, only to have to be removed within the next year or two.
You can't use 22852 because it is not segmental instrumentation. You can't use 22849, reinsertion of spinal fixation device (which includes removal) because again, the distractor is not a fixation device.
If the removal was the only procedure the surgeon was doing, you could consider 20680 (removal of implant; deep), however, since this is a "separate procedure" and since it is always necessary to do another procedure to address the patient's problem, it is not billable with the current laminectomy, fusion and instrumentation.
Not what your surgeon wants to hear, but I hope this helps you think through it.
 
Removal spinous process distractor

Thank you for your response which was exactly my inclination. It's nice to have confirmation. Have a great weekend.

Theso13
 
You would not bill the removal of the X-Stop (0171T) but you would bill the insertion of the other instrumentation using 22840 since it was done posteriorly. The codes I would use is 22612,63030, and the 22840. If there was an interbody fusion done then I would replace the 22612 with 22633. Hope this helps
 
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