Neurosurgery Coding Alert

Question: I am very interested in learning more about the changes to code 22840 between the 1999 and 2000 editions of the CPT. How do these changes impact neurosurgeons?

Missouri Subscriber

Answer: A probable reason for this change stems from the CPT language for code 22842 (posterior segmental instrumentation [e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires; 3 to 6 vertebral segments).

By comparison of the prior definition, the Harrington rod and other nonsegmental techniques (22840) involved laminar fixation at any level in between. The segmental instrumentation (22842) required the fixation of at least one interval segment. Pedicle fixation did not fit into either of these descriptions: There was no indication that the pedicle fixation could be reflected by the nonsegmental code, and no third segment fixation in a two-segment procedure. As the two-segment pedicle fixation procedure became more common, many neurosurgeons used code 22842 with modifier -52 (reduced services) to indicate the segmental fixation of less than three levels. The new language in code 22840 corrects this discrepancy.