Neurosurgery Coding Alert

Question: How do we code for the spinal hardware injections?

Alabama Subscriber

Answer: Your surgeon is likely performing a "hardware injection" when he is injecting lidocaine alongside the spinal pedicle screws previously placed during spinal instrumentation surgery. If the patient continues to experience pain after spinal fusion with hardware placement, your surgeon may inject an anesthetic as a diagnostic or therapeutic injection to determine if the hardware is the source of the patient's pain. There is no specific code for hardware injection. This is neither an epidural procedure nor a nerve block. It is just the diagnostic injection of an anesthetic. You may report 22899 (Unlisted procedure, spine) or 64999 (Unlisted procedure, nervous system), both of which are unlisted. Since this type of injection is actually an intramuscular injection, one may alternatively consider using the trigger point injection code 20552 (Injection[s]; single or multiple trigger point[s], 1 or 2 muscle[s]).