Neurosurgery Coding Alert

Question: A neurosurgeon performed an anterior lumbar exposure, a radical diskectomy L4-L5 and L5-S1, interbody fusion cage insertion with two cages at L5-S1 and closure, all done with fluoroscopy. I was going to code 22558, 22585, 22851, 22851 and 76003-26. Because it was a radical diskectomy, I should be able to charge for an anterior lumbar diskectomy, but which code should I use?

Florida Subscriber

Answer: Although a code exists for an anterior thoracic diskectomy, there is no code for an anterior lumbar diskectomy. Some payers say a lumbar diskectomy would automatically be included in the anterior fusion, and if so, 22558 would be correct. But 22558 (anterior approach for lumbar fusion [anterior retroperitoneal exposure]) specifically states that it includes minimal diskectomy for preparation of the fusion site. However, a radical diskectomy (which presumably would include a nerve decompression) was performed and should be separately payable.

It is advisable to use an unlisted procedure code (64999) for each level of the anterior lumbar diskectomy rather than an analogous code like the anterior thoracic diskectomy code (63077) to reflect more accurately the work that was done and to avoid disagreement between your procedural and diagnostic codes. However, refer to the RVUs for the analogous code (63077) to set a rate for the service, and document that you have done this and your reasoning.

It is correct to list 22851 (application of intervertebral biomechanical device[s] [e.g., synthetic cage(s), threaded bone dowel(s), methylmethacrylate] to vertebral defect or interspace) twice because it was done at two levels. Code 76003-26 (fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device) is acceptable because of the mention of a localization device.


Answers provided by Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno, a coder who specializes in neurosurgical procedures; Susan Callaway, CPC, CCS-P, independent coding educator and consultant in Augusta, S.C.; and Arlene Morrow, CPC, an independent coding and reimbursement specialist in Tampa, Fla.