Anesthesia Coding Alert

Question: Which CPT codes are used to report L4-5 syntheses screws/rods and L4-5 prolateral fusion using bone from the patients left iliac crest? Which procedure is considered the primary one? Which anesthesia codes would be associated with the procedures?

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Answer: CCI allows the anesthesiologist to bill only one anesthesia code (that with the highest amount of base units), but he or she can include the total time associated with all surgical procedures. In this scenario, the surgical CPT code would be 22842 (posterior segmental instrumentation [e.g,. pedicle fixation, dual rods with multiple hooks and sublaminar wires]; 3 to 6 vertebral segments). Code 22842 crosswalks with anesthesia code 00670 (anesthesia for extensive spine and spinal cord procedures [e.g., spinal instrumentation or vascular procedures]), which carries a base value of 13 units plus time units. The prolateral fusion would not be billed with a separate anesthesia code.
 
CPT 2001 defines segmental instrumentation as fixation at each end of the construct and at least one additional interposed attachment. A vertebral segment describes the basic constituent part into which the spine may be divided. It represents a single complete vertebral bone with its associated articular processes and laminae.