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Due to hardware failure, the physician removed non-segmented instrumentation (rod and locknuts)at L4-5. He then did a posterolateral fusion of L3-L5. Would 22850 and 22612 be the appropriate codes?
PROCEDURE PERFORMED:
Removal of instrumentation with expiration fusion.
Pedicle screw fixation L3 with extension of effusion to the L3L4 spanning to the L4L5 level.
Extension of the posterolateral fusion L3 to L5.
Biplane fluoroscopic interpretation.
dissection was carried down to the hardware. The lock nuts were removed and it appeared the right L4 lock nut was stripped. Subsequently the lock nuts were removed, rod was removed as well. The posterior gutters were visualized once again decorticated the transverse process at L4 and L5 using a Cobb. I then targeted the pedicles at the L3 level extending the fusion upward. Using the PediGuard probe I docked at the lateral aspect and advanced under direct orthogonal views with no indication of breaching the cortical bone. A blunt guidewire was then placed into the L3 vertebral body. This was done on the left as well. A size 60/45 screw was then placed without complication. Guidewires were removed. I then targeted the L3L4 level using Kambin triangle using a Jamshidi needle. I advanced and subsequently there was a calibration issue with the Carm. Thus it was decided not to perform the anterior arthrodesis at the L3L4 level and to simply extend the posterolateral fusion up to the L3L4 level. Decorticated the transverse processes at L3 and then irrigated with copious amounts of irrigation, 10 mL of Healos combined with 5 mL of Evo3c were then placed into the lateral gutters, combined with the decorticated bone bilaterally. Needle counts and sponge counts were correct. Final AP and lateral xray showed good hardware placement with reduction of the slip at the L4L5 level
The documentation is a little bit confusing but it looks like he removed the hardware from L4-L5, then placed at L3-L4 with fusion at L3-L4. If this is the case then I would bill 22612, 22850 and 22840 with the appropriate graft code.