Neurosurgery Coding Alert

Question: Is anyone else having issues getting 22614 (Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment [List separately in addition to code for primary procedure]) paid with 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) and/or 22634 (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; each additional interspace and segment [List separately in addition to code for primary procedure]) when a posterolateral fusion is being performed at an additional level than the combined PLIF/PL fusion (Example: PLIF/PL fusion done at L4-5 with a PL fusion only at L3-4)?

Florida Subscriber

Answer: According to CPT®, you report 22614 as an add-on for 22633 if your surgeon does the arthrodesis at two different levels. You may be facing the denial as your surgeon is doing PLIF/PL fusion at L4-5 and just a PL fusion at L3-4. Appending the additional level posterolateral arthrodesis code 22614 with the 59 (Distinct procedural service) modifier to identify the separate site may help.