Neurosurgery Coding Alert

Question: There is a debate in our office, and we were hoping you could help settle it. Is it true that you cannot bill removal of instrumentation at the same or adjacent levels as placement of new instrumentation?

California Subscriber

Answer: Yes. This is true.

You should not report 22849 (Reinsertion of spinal fixation device) in conjunction with 22850 (Removal of posterior nonsegmental instrumentation (eg, Harrington rod)), 22852 (Removal of posterior segmental instrumentation), and 22855 (Removal of anterior instrumentation) at the same spinal levels, according to the CPT^® guidelines. Also, you should only report the appropriate insertion code from add-on spinal instrumentation codes +22840-+22848 when the surgeon removes or revises previously placed spinal instrumentation during the same session where he inserted new instrumentation at levels, including all or part of the previously instrumented segments, even if the overlap is a single vertebral segment.

Remember: You should not report reinsertion code 22849 or removal codes 22850, 22852, and 22855 in addition to new instrumentation codes +22840-+22848. Additionally, codes 22849, 22850, 22852, and 22855 are subject to modifier 51 (Multiple procedures), if you are reporting them with other definitive procedures such as arthrodesis, decompression, and exploration of fusion.