Neurosurgery Coding Alert

Question: Could you please explain the difference between codes 22612 and 22633?

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Answer: Codes 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar [with lateral transverse technique, when performed]) and 22633 (Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace [other than for decompression], single interspace and segment; lumbar) are both codes for posterior lumbar arthrodesis, but the specific location of the fusion performed is different.

What is arthrodesis? Arthrodesis, also called spinal fusion, implies a procedure wherein your surgeon will fuse or join one vertebra to an adjacent vertebra.  Your surgeon may perform an arthrodesis in patients with a painful disc, degenerative disc disease, disc herniation, fracture, infection or dislocation of the lumbar spine.

How are 22612 and 22633 different? Here are examples to explain the difference between 22612 and 22633.

22612 is a code for a single level posterior lumbar arthodesis. The code descriptor can be confusing as it mentions ‘single level’ rather than ‘single interspace.’ Arthrodesis refers to fusion of a motion segment, i.e., two adjacent vertebrae and the intervertebral disc. This fusion is not performed within the disc space itself but rather on other bony surfaces of the posterior spine.

Example: If you read that your surgeon fuses vertebrae L1 through L3 across the transeverse processes, you should report 22612 along with a single unit of +22614 (... each additional vertebral segment [list separately in addition to code for primary procedure]). Your surgeon performed two fusion levels though the procedure involved three vertebrae. So you count the segments and not the levels. Here, your surgeon is fusing segment L1 to segment L2 (22612) and segment L2 to segment L3 (22614).

Code 22633 describes a posterior lumbar arthrodesis performed both in the disc space as well as on other bony surfaces of the posterior spine.  This procedure also includes laminectomy and discectomy. You report 22633 when your surgeon does both a posterior interbody arthrodesis and a posterolateral arthrodesis.

Example: You may read that your surgeon does a bilateral hemilaminectomy with diskectomy and foraminotomy for nerve decompression and a lumbar decompression with posterior lumbar interbody fusion and posterior lateral transverse fusion. In this case, you report code 22633. You would not separately report the posterior lumbar interbody fusion, in which a laminectomy, facetectomy and discectomy are performed with decortications of the vertebral endplates and insertion of graft material between them. So, you do not report 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace [other than for decompression], single interspace; lumbar) for posterior interbody technique and 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar [with lateral transverse technique, when performed]) for posterior lateral transverse fusion. Code 22633 is a combined code for these procedures. Also, discectomy is an inherent part of posterior interbody arthrodesis. You would not report 63030 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, lumbar). Additionally, you may report the appropriate codes for instrumentation if any was done.