Neurosurgery Coding Alert

Question: Our surgeon performed segmental spinal stabilization using axis plate at C6-T1. I reported this using 22840 but am having problems receiving payment. What am I doing wrong?

Neurosurgery Discussion Group Participant

Answer: Code 22840 (Posterior non-segmental instrumentation [e.g., Harrington rod technique, pedicle fixation across one interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation]) describes placement of non-segmental instrumentation. In this case, however, you state that the surgeon placed segmental instrumentation from C6-T1 (or three vertebral segments: C6, C7 and T1), which you should report as 22842 (Posterior segmental instrumentation [e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires]; 3 to 6 vertebral segments).

In addition, you should claim the accompanying fusion procedures. For fusion of segments C6/C7, report 22600 (Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment) with +22614 ( each additional vertebral segment [list separately in addition to code for primary procedure) for the fusion of C7/T1. As an alternative, you may report the thoracic (C7/T1) fusion first using 22610 ( thoracic [with or without lateral transverse technique]) and claim +22614 for the C6/C7 fusion. Either method accurately describes the procedures performed, and payment is nearly identical.

Do not, however, report 22600 and 22610 together: Payers will consider this double-billing because you will be charging twice for the approach, closure and postoperative management. Choose one primary procedure code for the first fusion (either 22600 or 22610) and report add-on code +22614 for each additional segment.