Neurosurgery Coding Alert

Question: The neurosurgeon performs a surgical procedure including a posterior lumbar fusion with instrumentation across one interspace, L3-L4, using TSRH pedicle screw fixation. This is coded 22840. CPT 2001 does not describe this procedure as bilateral or unilateral or as dual rod versus single rod. If the neurosurgeon places screws and rods on both left and right pedicles of L3 and L4, would the following be correct coding?

 1. 22840
 2. 22840 x 2 (left and right sides)
 3. 22842
 4. 22842-52

The justification for numbers 2, 3 and 4 would be the placement of two sets of rods and four screws, indicating more work than a single rod and two screws. In addition, a brace is sometimes attached between the two rods for additional support.

California Subscriber

Answer: Code 22840 (non-segmental spinal instrumentation) should be billed for two fixators and a connector that may span two vertebral segments, whether unilateral or bilateral, says Michael W. Potter, MD, a practicing neurosurgeon for 19 years in Medford, Ore, and president of Cascade Neurosurgery and Spine Inc. Code 22842 (posterior segmental instrumentation [e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires]; 3 to 6 vertebral segments) would only be appropriate if the instrumentation extended to three or more segments with a third fixation between the two endpoints. Just as you should not code twice for two cages at the same interspace, it is incorrect to code twice for performing this procedure bilaterally.