Neurosurgery Coding Alert

Question: If a neurosurgeon places pedicle screws at L3 and L5 and connects a rod between the two segments,(this means that it spans three segments [L3, L4 and L5], but only connects to two [L3 and L5]), would this be considered non-segmental instrumentation?

Conversely, if a neurosurgeon placed screws at L3, L4 and L5, and connected a rod to all three, would this be considered segmental instrumentation?

Illinois Subscriber

Answer: Instrumentation (22840-22848) is placement of fixation devices, usually rods, along the spine to provide added stability. Posterior instrumentation may be non-segmental or segmental. If there is placement with instrumentation only at the ends, then its non-segmental, no matter how many segments it spans. For example, the code for posterior non-segmental instrumentation is 22840. (There is no code for non-segmental anterior instrumentation.) If one or more intermediate segments are instrumented, then it is segmental instrumentation. A common segmental instrumentation technique is the Harrington rod, which is placed with screws along the spinal column, attached at the top, bottom and several locations in between. Codes for segmental instrumentation are based on the total number of segments spanned, including the end segments. For instance, 22842 covers three to six segments, 22843 covers seven to 12, and 22844 covers 13 or more.