Spinal Surgery, Please help!


Las Vegas, NV
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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
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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.)