Neurosurgery Coding Alert

Question: Our surgeon performed 3 procedures for cervical fusion to fix a kyphotic cervical deformity.

1) The first one was an anterior approach for C5 and C6 cervical corpectomy and C4 through C7 anterior cervical diskectomy using microscope, fluroscopy for 3 hours. Craniocervical distraction pins were placed during the operation for in line traction. No hardware was placed in this approach.

2) Second was a posterior approach in which lateral mass and pedicle screw instrumentation was done from C2 to T2 for cervicothoracic kyphosis and posterolateral fusion was done from C2 to T2 using microscope and use of fluoroscopy for 2.5 hours.

3) Third was an anterior approach with placement of anterior cervical cage and plate between C4 and C7, anterior cervical fusion between C4 and C7 using microscope and fluoroscopy.

Please help to determine the correct codes for these procedures.

Minnesota Subscriber

Answer: For the anterior approach vertebral corpectomy at C5, you report code 63081 (Vertebral corpectomy [vertebral body resection], partial or complete, anterior approach with decompression of spinal cord and/or nerve root[s]; cervical, single segment). You report +63082 (Vertebral corpectomy [vertebral body resection], partial or complete, anterior approach with decompression of spinal cord and/or nerve root[s]; cervical, each additional segment [List separately in addition to code for primary procedure]) for C6 corpectomy. The intraoperative cranial traction as well as intervertebral discectomies are considered bundled services with the corpectomies. However, if microdissection was performed and documented, you may additionally report 69990.

For posterolateral fusion from C2 to T2, you report codes 22600 (Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment) for the C23 arthrodesis and, +22614 (Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment [List separately in addition to code for primary procedure]) x 6 for the additional levels from C34 to T1-2. You report posterior screw fixation with instrumentation code +22843 (Posterior segmental instrumentation [e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires]; 7 to 12 vertebral segments [List separately in addition to code for primary procedure]).

For anterior cervical fusion between C4 and C7, you turn to 22554 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression); cervical below C2) and +22585 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression]; each additional interspace [List separately in addition to code for primary procedure]) x 2. You report the spinal cage with code +22851 (Application of intervertebral biomechanical device[s] [e.g., synthetic cage(s), methylmethacrylate] to vertebral defect or interspace [List separately in addition to code for primary procedure]). Finally, the anterior plate fixation, you would additionally report 22846.