• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
  • Important Note: We will be performing a scheduled maintenance on 1st November 2020. The site will be offline from 7:30PM (MT) till midnight. We apologize for any inconvenience this may cause.

Spinal Surgery, Please help!


Corona, CA
Best answers
Hello Everyone:
Could someone out there who has strong spinal coding skills, please give me some advice on the procedure below. I have also given the codes I think are correct. I am starting to go stir-crazy, thanks so much!
1. Posterior lumbar arthrodesis, T10 to L2 (4 levels)-22633
2. Posterior segmental spinal instrumentation, T10 to L2 (4 levels)-22634
3. Revision of posterior spinal arthrodesis at L2 to L3 (1 level)-22634
4. Removal of posterior fusion rods, L2 to S1, and revision of posterior fusion, L2 to S1-22852
5. Smith-Petersen osteotomies w/complete lamectomies and facetectomies bilaterally at T 12 to L1 and L1 to L2-???
6. Exploration of Fusion, L2 to S1 bilaterally-cannot bill
7. Vertebral augmentation L2 w/cement-???
8. Placement of cement to augment screws at T10, T11, T12 bilaterally-22842
9. Placement of allograft cancellous bone for fusion at T10 to S1-20930
10. Placement of local morelized autograft bone for fusion at T10 to S1-20937
11. Placement of Infuse bone morphogenetic protein 2 for fusion T10 to S1-64999
Last edited:


Best answers
Osteotomies are done for correction of a spinal deformity such as arthritis, severe kyphosis, etc, so make sure he really did an osteotomy but I would bill as follows. 22633 and 22634 x 3 for the fusion done at T10-T11, T11-T12, T12-L1, L1-L2. ( the criteria for billing 22633 and 22634 says it has to be a combined posterior with posterior interbody approach. The surgeon only dictates posterior, based on the instrumentation, he probably did the interbody too but I would ask him to clarify future dictation). I would bill 22842 for the instrumentation, 22852 for the removal of instrumentation, 22214 and 22216 x 2 for the osteotomies (but review the body of the OR and make sure he really did osteotomies at 3 segments, if it looks more like just two, bill 22216 once. 22851 for the placement of the cement. 20930 is what you use for BMP, not 64999 and I would only bill 20930 once. And local bone is 20936 not 20937. (20937 is used when it is a separate incision like hip graft, 20936 is for from the same incision.)