# Spine instrumentation removal & reinsertion



## knedley (Mar 6, 2014)

I have a question and could use guidance/direction, please.

My spine surgeon performed procedures in January - PLIF T12-L3, and reinserts hardware from L2-S1.  Also performs an ALIF L2-S1 with interbody cages L3-L5. 

Patient is returning for loose hardware on 3/3.  Posteriorly a screw removed @ T12 due to movement of screw.  This is not replaced.

He removes screws from L2-S1( previous placement in January) due to rod disengagement and reinserted necessary screws for appropriate correction to hardware at these levels.   Fusion is also explored at this time.

QUESTION:  I am wanting to code 22849-78 (reinsertion of spinal fixation device) & 22830-51,78 (Exploration of fusion).  Does the screw being removed at the T12 level  justify coding 22852 (removal of posterior segmental instrumentation) because it was not reinserted or would a different CPT, such as 20680 be added or would no additional CPT be appropriate in this scenario?

Thank you for your time for your thoughts.


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## nrichard (Mar 7, 2014)

*I?m assuming you?re talking about the second surgery.*

You can only use 22849, when the hardware is being removed and replaced at the exact same spinal levels. 
You can use 22852-78 alone though.  I would use this rather than 20960, because that is for a deep pin or wire, this is actually spinal instrumentation, justifying the 22852


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## knedley (Mar 10, 2014)

Nichole,

Yes I was referring to the second surgery.  Particularly the screw removal.  I did code the 22849 for the reinsertion.  I was questioning the use of 22852 for the removal of just the screw.  Even though this was a separate level, I had concern using 22852 because it was just a screw and not other hardware.


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## seslinger (Mar 13, 2014)

On page 118 of the CPT 2014 Profession Edition, last paragraph, middle of the paragraph it states 

"Only the appropriate insertion code (22840-22848) should be reported when previously placed spinal instrumentation is being removed or revised during the same session where new instrumentation is inserted at levels including all or part of the previously instrumented segments.  Do not report the reinsertion (22849) or removal (22850, 22852, 22855) procedures in addition to the insertion of the new instrumentation (22840-22848)"

So I usually will code a new insertion of instrumentation.  See what you think.

Sheila, CPC


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