# spinal surgery



## tdiederich (Feb 24, 2009)

Can someone please help me with this one?  I need some direction on removal and reinsertion of spinal fixation device.  Our Dr is removing nonsegmental insutrumentation @ L4-L5 and applying segmental instrumentation @ L4, L5, S1.  Do I code just 22849 or do I code 22850 & 22742?  Any help would be greatly appreciated.

Thanks,
Tisha


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## RebeccaWoodward* (Feb 24, 2009)

Ok...I see a couple of things.  CPT code 22742 doesn't exist.  Did you mean 22842?  If so, 22842 is an add on code.  It can't be reported, alone, with 22850.  22849 is reported when instrumentation is removed and reinserted at the same exact level during the same operative session. Is there anything else you can post regarding the surgery?


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## tdiederich (Feb 24, 2009)

Yes, I did mean 22842, sorry.  The other procedures performed:

1. Unilateral Hemilaminectomy w/partial facetectomy and foraminotomy, L5-S1
2. Bilateral Hemilaminectomy, reexploration, L4-L5
3. Posterior Lumbar Interbody Fusion, L5-S1
4. Posterior Spinal Fusion, L5-S1
5. Exploration spinal fusion
6. Application of segmental insturmentation, L4,L5,S1
7. Removal of nonsegmental instrumentation L4, L5
8. Application of intervertebral biomechanical device
9. Applicaiton and removal of cranial tongs.
10.Autograft for spine surgery, single incision
11.Use of bone morphogenic protein for fusion
12.Somatosensory evoked potential and electromyography potentials monitored throughout the entire procedure


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## RebeccaWoodward* (Feb 24, 2009)

This is clearer now.

Since instrumentation was removed at L4-L5 and new instrumentation was placed at L4-L5-S1, I would go with the 22850 and 22842. Modifier 59 should  be appended to CPT code 22842 to indicate new instrumentation at a new level.


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## tdiederich (Feb 24, 2009)

Thanks for your help!  

Tisha


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