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Wiki SPINAL CODING

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dchkncoop1

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Grand Island, NE
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Hey all-
I really need help here.
We have a patient that had an ACDF C3-4, C5-6 with auto fusion of C4-5. I used CPT 22845 for the instrumentation but am being told it should have been 22846. The provider states he did not do instrumentation C4-5. Did I count the segments incorrectly? Can someone educate me on this?
Thanks so much!
 
If no hardware was placed at levels below C4, then 22845 would be correct. And sounds like you understand segment count for this scenario.
Seems odd that C4-C5 wasn't added for instrument to support C3-C4, but doesn't surprise me. Good luck!
 
Segment and interspace are not the same thing. So, here you would count a total of 4 segments. 3,4,5,6. If there was hardware placed from 3-4 (2 segments), skip 4-5, and 5-6 (2 segments) = four or 22846. It has to span the segments though. it would be helpful to see the op note or else we can't be 100% sure.

(old link may not be 100% accurate anymore but concepts apply)
Vertebral Segment: CPT defines the Vertebral Segment as the basic constituent part into which the spine may be divided. It represents a single complete vertebral bone with its associated articular processes and laminae. Vertebral Interspace: CPT defines the Vertebral Interspace as the non-bony compartment between two adjacent vertebral bodies, which contains the intervertebral disc, and includes the nucleus pulposus, annulus fibrosus, and two cartilaginous endplates.

Vertebral Interspaces are identified with a “-” i.e.: C3-C4, C4-C5 for interspaces for discectomies. Vertebral Segments are identified with a “,” i.e.: C3, C4, C5 for segments of corpectomies.
 
dchkncoop1 said:
Hey all-
I really need help here.
We have a patient that had an ACDF C3-4, C5-6 with auto fusion of C4-5. I used CPT 22845 for the instrumentation but am being told it should have been 22846. The provider states he did not do instrumentation C4-5. Did I count the segments incorrectly? Can someone educate me on this?
Thanks so much!
Click to expand...

Here is the OP report. Please explain to me which CPT code I should be using and why.
I really appreciate your help!!

1677010880589.png
 
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