Neurosurgery Coding Alert
Fixation Points Determine Instrumentation Type
Question: If the surgeon places pedicle screws at L3 and L5 and connects a rod between the two segments, is this segmental or nonsegmental instrumentation (the rod spans three segments but only connects to two)? What if the surgeon places screws at L3, L4 and L5 and connects a rod to all three? Missouri Subscriber Answer: Nonsegmental instrumentation (22840) is fixed at two points only, no matter how many segments there are between the fixation points.
In the first case above, therefore, the instrumentation is nonsegmental. There are two fixation points (L3 and L5) with at least one segment (L4) between them.
In the second case, however, there are three fixation points (L3, L4 and L5). Therefore, the instrumentation is segmental (22842-22847, as appropriate).
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