Neurosurgery Coding Alert

Question: Our surgeon did the following procedures using the posterior thoracolumbar approach:

"Open reduction of L1 burst fracture; T12, L1, L2 pedicle screw segmental instrumentation for stabilization; T12-L2 posterolateral arthrodesis using cancellous allograft bone chips and DBM putty."

Below is how the operative note reads:

"...posterior elements of T12, L1 and L2 were exposed. Using the DePuy EXPEDIUM system, we inserted 7.0 x 50 screws at T12 bilaterally as well as L2 bilaterally and 7.0 x 45 screws at L1 bilaterally. We went ahead and connected two appropriate size rods and final tightened set screws on there to complete the T12-L2 stabilization and in the process reduction of the L1 burst fracture.  .....then decorticated the posterior elements of T12, L1and L2 using a high-speed match stick drill.  We then went ahead mixed allograft cancellous bone chips with DBM putty and laid it on the posterior element to complete the T12, L1, L2 posterior arthrodesis.  There was excellent hemostasis."

Can we bill 22614 (Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment [List separately in addition to code for primary procedure]) twice in this case?

New Jersey Subscriber

Answer: Your operative note describes a posterolateral arthrodesis at L1-L2 that would be reported with 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar [with lateral transverse technique, when performed]) and an additional level arthrodesis at T12-L1 that would be reported with 22614. Since only two joints have been fused, a second additional level was not performed and would not be reported.

The segmental posterior pedicle screw instrumentation would be reported with 22842 (Posterior segmental instrumentation [e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments [List separately in addition to code for primary procedure]). The incidental reduction with placement and connection of the spinal instrumentation would be considered incidental to the instrumentation placement and not separately reportable. The cancellous allograft and demineralized bone matric would be reported with 20930 (Allograft, morselized, or placement of osteopromotive material, for spine surgery only [List separately in addition to code for primary procedure]).