Neurosurgery Coding Alert

Question: Our surgeon performed corpectomies at C4 and C5, fusion(s) from C3-C6 with polyetheretherketone (PEEK) cage and 30 mm screws. To fill up the space, our surgeon used three separate, stackable, PEEK cages. How can we report this procedure?

Kansas Subscriber

Answer: In the case described by you, the surgeon has fused across 3 levels - C3-4, C4-5, C5-6 and used three cages. You will report the primary procedures with 63081 (Vertebral corpectomy [vertebral body resection], partial or complete, anterior approach with decompression of spinal cord and/or nerve root[s]; cervical, single segment) and 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 the corpectomies, assuming that more than half of the vertebral body was removed. To account for device application, you would report 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]) once, since the prosthetic devices were filling a single intervertebral defect, which is the space between C3 and C6 after the C4 and C5 corpectomies were performed.

Locate the Fusions: Submit codes 22554 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression]; cervical below C2) with modifier 51 (Multiple procedures:…..) 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]) x2 for the fusions of C3-4, C4-5 and C5-6.

Isolate the Instrumentation: You may additionally report any instrumentation performed. If a plate and screws were placed spanning from C3 to C6, you would also report code 22846 (Anterior instrumentation; 4 to 7 vertebral segments [List separately in addition to code for primary procedure]).

Capture the Bone Graft: You should also report the bone graft. More often than not, spine surgeons use locally harvested autograft bone from the corpectomy  which would be reported with code +20936 (Autograft for spine surgery only [includes harvesting the graft]; local [e.g., ribs, spinous process, or laminar fragments] obtained from same incision [List separately in addition to code for primary procedure]).

If the surgeon uses bone morphogenic protein, you code +20930 (Allograft, morselized, or placement of osteopromotive material, for spine surgery only [List separately in addition to code for primary procedure]). Others fill the cage with some type of synthetic graft combined with bone marrow aspirate harvested from the patient which is usually from the iliac crest. In this case, you may report 38220 (Bone marrow; aspiration only).