Neurosurgery Coding Alert

Do not report the removal codes with the insertion codes.

According to CPT® 2012, you will see a change in the guidelines for instrumentation for spinal procedures. Below is a quick update on the new instrumentation revisions.

What is new in 2012? The revision for CPT® 2012 in spinal instrumentation specifies that you will only use the insertion code when your surgeon does a removal with change of instrumentation in overlapping spinal levels. You apply this even if your surgeon does the insertion at new levels when there is an overlap with the previously instrumented segments.

2 key changes: When you are reporting spinal instrumentation in 2012, make sure you apply the following revisions:

1. You should not report code 22849 (Reinsertion of spinal fixation device) for reinsertion of instrumentation and codes 22850 (Removal of posterior nonsegmental instrumentation [e.g., Harrington rod]) -22855 (Removal of anterior instrumentation) for removal of instrumentation with the insertion codes +22840 (Posterior non-segmental instrumentation [e.g., Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation] [List separately in addition to code for primary procedure]) and +22848 (Pelvic fixation [attachment of caudal end of instrumentation to pelvic bony structures] other than sacrum [List separately in addition to code for primary procedure]).

2. When your surgeon inserts new instrumentation at levels adjacent to previously instrumented segments and also removes or revises the previously placed instrumentation in the same session such that there is an overlap between the originally placed instrumentation and the newly placed instrumentation, you only report the appropriate insertion code (+22840-+22848). You will not report the reinsertion (22849) or removal (22850, 22852 [Removal of posterior segmental instrumentation], and 22855) procedures in addition to the insertion of the new instrumentation (+22840-+22848).