# Posterior instrumentation....HELP!



## njohnson0476 (Nov 2, 2009)

Hello All,
I have a surgery, and it appears that the screws, pins, and rods were placed percutaneously.  I am a newby to spine coding, and want to make sure this is right.  

*Can you use 22842 if the instrumentation is placed percutaneously*?  Or do you have another code that shoud be used.  This is a 360 fusion.  I will enclosed the posterior portion of the op report:

Next the patient was flipped prone on the Jackson table.  Intraoperativ C-arm was brought back into the room to confirm the L5 pedicles.  Jamshidi needles were first place through the L5 pedicles as well as the S1 pedicles.  The Jamshidi needles were removed, and Steinmann pins were placed down through all all four pedicles.  Next, the left-sided L5 pedicle was tapped, and a 6.5 X 40-mm screw was placed through that pedicle under direct fluoroscopy.  Similarly, the left S1 pedicle screw was placed under floroscopy using a 6.5 X 35-mm screw.  The right L5 and S1 pedicle screws were placed in similar fashion using 6.5 X 40-mm screws.  Omnce the screws were in place, 40-mm rods were percutaneously laced through both pedicle screws on the left and right sides.  they were secured in place with set screws.  All four screws, prior to rod placement, were stimluated and did not have any response to 40 milliamps.


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## kjstearns (Nov 2, 2009)

Yes, bill 22842.


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## RebeccaWoodward* (Nov 2, 2009)

Looks OK...

CD HORIZON® SEXTANT _*Percutaneous*_ Rod Insertion System

Cannulated M8 Multi Axial Screws allow for placement of screws over a guidewire. When used with the CD HORIZON SEXTANT Percutaneous Rod Insertion System, these screws allow for the placement of rods in a minimally invasive fashion. An arc places the rod through the skin and into the heads of the screws. Pre-loaded set screws tighten the pre-cut and pre-bent rods to the screws without the disruption of muscle required in traditional open procedures.

*Physician Coding/Reimbursement*

The following CPT codes may be appropriate to report posterior instrumentation using the CD HORIZON SEXTANT Percutaneous Rod Insertion System. The physician should report the CPT code that best describes the procedure performed.

*22840 *Posterior non-segmental instrumentation segments
*22842* Posterior segmental instrumentation; 3 to 6 vertebral segments

This is an example but it provides a scenario when this is applicable...

http://www.sofamordanek.com/spineline/hospital/MAST_Tech.pdf


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## njohnson0476 (Nov 3, 2009)

Thanks!


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