Neurosurgery Coding Alert

Question: Are instrumentation codes 22840 and 22842 unilateral only? For example, if the surgeon places two rods and fours screws (one rod and two screws on each side of the vertebrae), may we report 22840 x 2 or 22840 with the bilateral modifier?

California Subscriber Answer: You should not bill separately for spinal instrumentation placed on the left and right side of the spine. Instrumentation codes 22840 (Posterior non-segmental instrumentation [e.g., Harrington rod technique, pedicle fixation across one interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, face screw fixation]) and 22842 (Posterior segmental instrumentation [e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires]; 3 to 6 vertebral segments) - as well as 22843-22844 - are inherently bilateral. You should assign the segmental codes based on the number of levels spanned. For instance, 22842 covers three to six segments, while 22843 covers seven to 12, and 22844 covers 13 or more.