# Spinal Instrumentation (screws & rods)



## geugene (Oct 13, 2009)

To my fellow coders, 

My physician performed a wide cervical laminectomy at c3 to c6. (63015) with posterolateral fusion with lateral mass screws. (22600, 22614 x 3). He removed the spinous process which was later mixed with demineralized bone matrix and used in a bone graft. (20930). He applied posterolateral screws at c3, c4, c5, & c6. Then he placed rods on the screws. I coded 22842 (3 to 6 vertebral segments). *My questions is do that code represent the screws and rods or should I pick up 22842 x 2 to represent the rods separately?*

Also when coding for *bone graft if spinous process from lamina and a aspirated bone marrow from the iliac crest is used, what is the correct way to code this? (20937 & 38220)*

Thanks for your feedback


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## kjstearns (Oct 13, 2009)

My understanding is that you can only bill the 22842 one time. As for the bone graft, I'm showing that 38220 is bundled into 20937. I'm not sure if you are able to un-bundle it or not. I'd also be interested in what other people's opinions are on that.


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## RebeccaWoodward* (Oct 13, 2009)

geugene said:


> To my fellow coders,
> 
> My physician performed a wide cervical laminectomy at c3 to c6. (63015) with posterolateral fusion with lateral mass screws. (22600, 22614 x 3). He removed the spinous process which was later mixed with demineralized bone matrix and used in a bone graft. (20930). He applied posterolateral screws at c3, c4, c5, & c6. Then he placed rods on the screws. I coded 22842 (3 to 6 vertebral segments). *My questions is do that code represent the screws and rods or should I pick up 22842 x 2 to represent the rods separately?*
> 
> ...




22842 covers, both...the screws and rods.

I noticed you have 22614 x 3...

Wouldn't it be 22614 x 2?

22600=C3-C4
22614=C4-C5
22614=C5-C6

38220 is a component of 20937 but can be unbundled if separate incisions were made.


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## geugene (Oct 13, 2009)

My thoughts when I picked 22614 were that the description stated vertebral segments. I also read an article in Neurosurgery Coding Alert 2008 vol 9 #7 which told me to watch for such a thing. The articles stated that some of the arthrodesis codes stated *intraspace* and others *segments.* 

As for the graft, he often does the aspiration from a separate incision.

thanks for all your help.


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## RebeccaWoodward* (Oct 13, 2009)

*Example:*

The span T12-L4 contains 5 vertebral segments (T12, L1, L2, L3, L4) BUT only 4 vertebral interspaces (T12-L1, L1-L2, L2-L3, L3-L4)

As for C3-C6...You have 4 verterbal segments...C3, C4, C5, C6 vertebral segments; however, you only have 3 vertebral interspaces...

C3-C4, C4-C5, C5-C6=22600 226214x2





*Arthrodesis*

How would you code a fusion of L1 to L3? What are the appropriate procedure codes? Is it 22612, 22614, 22614 - three vertebral segments or are 22612, 22614 - 2 actual fusions - L1-L2, L2-L3? 

Proper coding of the above operative procedure pending the physician work is clearly stated in the operative note is 22612 and 22614 (L1-2, L2-3). Arthrodesis implies a fusion of a motion segment. A vertebral segment refers to two adjacent vertebra, and its intercalary disc; therefore, you should use 22614 only once.

http://www.spine.org/Pages/PracticePolicy/CodingAndReimbursement/FrequentlyAskedQuestions.aspx


Different approach...same concept


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## geugene (Oct 14, 2009)

Thanks for the information and link. I have a better udnderstand than before.
geugene


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