Neurosurgery Coding Alert

When the surgeon performs arthrodesis that spans two spinal areas (such as cervical and thoracic), you can report only a single "initial level" code. For each additional level, regardless of spinal area, you will report an appropriate add-on "each additional" code.

In every case, you will want to choose as the primary level code the highest-valued spinal area, says Nancy Reading, RN, BS, CPC, director of educational services for the American Academy of Professional Coders. For example, here are the physician work relative value units (RVUs) for the multi-regional arthrodesis procedures:

Example 1: The surgeon prepares interspaces T11-L2 for posterior fusion. You would report the following:

- 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar [with or without lateral transverse technique]) for the initial level (L1-L2)

- +22614 (- each additional vertebral segment [list separately in addition to code for primary procedure]) x 2 for levels T11-T12 and T12-L1.

In this case, we choose the lumbar code (22612) as primary over the thoracic code (22610) for the "cross region" procedure because the lumbar code reimburses at a higher level.

Example 2: Via anterior approach, the surgeon uses minimal discectomy to prepare interspaces C7-T3 for interbody fusion. In this case, you would report:

- 22556 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression]; thoracic) for arthrodesis at the initial level (T2-T3)

- +22585 (... each additional interspace [list separately in addition to code for primary procedure]) x 2 for each of the additional two levels C7-T1 and T1-T2.

We should choose the thoracic code (22556) over the cervical code (22554) to describe the primary arthrodesis level because the thoracic code pays more.