Neurosurgery Coding Alert

Want picture perfect spinal instrumentation claims? You need to determine if the instrumentation is segmental or non-segmental.

Good advice: -I would count the fixation points.Segmental is connected at the top, middle, and end. Nonsegmental is connected at the top and bottom,- says Rebecca Woodward, CPC, coding representative for MedVentures, LLC in High Point, N.C.

Non-segmental posterior instrumentation attaches to the spine at two points -- the proximal and distal portions (top and bottom) of the rod or other device -- with no attachment to any vertebrae between those points.

Example: A rod spanning from the first to fifth lumbar levels is attached to the spine at L1 and L5 but would not be attached at L2, L3, or L4.

You may report non-segmental posterior instrumentation placement using +22840 (Posterior nonsegmental instrumentation [e.g., Harrington rod technique, pedicle fixation across one interspace,atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation] ...).

Segmental posterior instrumentation attaches to the spine at three or more points, including the proximal and distal portions of the rod or other device.

Heads up: A rod spanning from the third cervical to third thoracic vertebra is attached at C3 and T3, but is also attached to at least one other segment between those two points (for example, C6 or C7). You may describe segmental posterior instrumentation placement using +22842 (Posterior segmental instrumentation [e.g.,pedicle fixation, dual rods with multiple hooks and sublaminar wires]; 3 to 6 vertebral segments ...), +22843 (- 7 to 12 vertebral segments ...), and +22844 (- 13 or more vertebral segments ...), as determined by the number of vertebral segments spanned.