Neurosurgery Coding Alert

Question: The doctor did an extreme lateral interbody fusion (XLIF) procedure on a patient, and then the patient returned to have a transforaminal lumbar interbody fusion (TLIF) with posterior lateral fusion procedure done. How can we report this procedure? Is it correct to report 22633, or is there any other revision code or possibly an additional code?

New York Subscriber

Answer: You should report the XLIF procedure as an anterior lumbar interbody fusion with code 22558 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression]; lumbar).  A physician would not perform an anterior and then a posterior interbody fusion at the same interspace, as these are duplicative.  Therefore, code 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) would not be applicable at the same level.  However, a posterolateral fusion reported with code 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar [with lateral transverse technique, when performed]) could be performed as a separately identifiable from the interbody fusion. 

From a CPT® coding perspective, posterolateral fusion and posterior interbody fusion are two distinct procedures. Unlike the posterolateral intertransverse fusion, the posterior lumbar interbody fusion (PLIF) helps to achieve spinal fusion in the low back when a bone graft and/or spinal implant (e.g., cage) is inserted directly into the disc space. When the surgical approach for this type of procedure is from the back, it is called a PLIF or transforaminal lumbar interbody fusion (TLIF), depending upon the trajectory of the approach.

Performing both posterior or posterolateral fusion and posterior interbody fusion at the same vertebral level in the lumbar region (e.g., L4-5) should be reported by one combined code. The code, 22633, represents both procedures. You can also use add-on code +22634 (….each additional interspace and segment [List separately in addition to code for primary procedure]) for each additional interspace and segment.