Spinal Instrumentation Removal / Revision

Chaffee, MO
Best answers
As noted in CPT 2012, "Only the appropriate insertion code (22840-22848) should be reported when previously placed spinal instrumentation is being removed or revised during the same session where new instrumentation is inserted at levels including all or part of the previously instrumented segments. Do not report the reinsertion (22849) or removal (22850,22852,22855) procedures in addition to the insertion of the new instrumentation (22840-22848)."

Once a year we have a meeting with a coding consultant. A question was posed asking if removal of instrumentation could be billed in addition to new instrumentation if performed at adjacent levels during the same operative session. The example given was removal of previously placed posterior instrumentation at L4-5, and placement of new instrumentation at L5-S1. The answer given was no, this is not separately reported and the appropriate code is 22840 only.

I'm just checking to see if this is thought to be an accurate answer among coding professionals. Thanks in advance for your feedback!
We are having the same problem. Patient came in for surgery 9-5-12, at that time cervical diskectomy and fusion, with three level instrumentation (C4-C7). On 9-7-12, hardware failure determined. The physician states he performed an exploration of the anterior cervical spine with removal of the old cervical plate and screws, and inserted new hardware at the same levels as the initial surgery on 9-5-12. On the 9-7-12 surgery we billed for the exploration (22830) and the new instertion (22846). The exploration was paid and reinsertion denied (22846) stating it was billed without a primary procedure. Our thoughts were the exploration would be the primary procedure for this encounter. We would appreciate any feedback regarding experience with coding this scenario. Thank you very much!
I believe you would bill 22849 for the reinstertion of hardware since the hardware is going back at the same levels. at not the 22846