Neurosurgery Coding Alert

Question: The neurosurgeon made a midline incision from the occipital protuberance down to the C5 level. He carried this incision down to the midline, down to the lamina. C1, C2, C3, C4 were easily identified as was the occiput. After the surgeon put retractors into place, he put the lateral mass screws in place into C2, C3, and C4 using imaging guidance. He then placed an occipital plate with four screws of 66 mm screws affixed to the occiput. Which CPT^® codes should we report for this service?

New Jersey Subscriber

Answer: For posterior occipitocervical fusion, you should report the following codes:

• 22590 (Arthrodesis, posterior technique, craniocervical (occiput-C2)) for fusion from the occiput to level C2
• 22600 (Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment) for C2-C3 fusion. You should append modifier 51 (Multiple procedures) to 22600.
• +22614 (Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure)) for C3-C4 fusion.
• +22842 (Posterior segmental instrumentation
• (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure)) for the occiput to C4 posterior spinal instrumentation.

The scenario also describes placement of screws with image guidance. This may be separately reportable, depending on the technique used. If a stereotactic computer-assisted navigational technique with preoperative planning was performed, you may also be able to report +61783 (Stereotactic computer-assisted (navigational) procedure; spinal (List separately in addition to code for primary procedure)).