Neurosurgery Coding Alert

Question: Our surgeon documented transpedicular three-column osteotomy via posterior approach to treat fixed sagittal imbalance at T10, T11 and T12. How should I code this?

New York Subscriber

Answer: CPT added a trio of new codes for 2008 to describe exactly this type of pedicle/vertebral body subtraction. They include:

- 22206 -- Osteotomy of spine, posterior or posterolateral approach, three columns, one vertebral segment (e.g., pedicle/vertebral body subtraction); thoracic

- 22207 -- - lumbar

- +22208 -- - each additional vertebral segment (list separately in addition to code for primary procedure).

As outlined in the code descriptors, 22206-22208 all include either posterior or posterolateral approach and involve three columns (the lamina with pedicles/facets, the posterior vertebral body, and the anterior vertebral body) within one vertebral segment.

Surgeons perform osteotomy of this type most commonly to treat fixed sagittal imbalance and loss of lordosis. The procedure removes posterior bone to increase the lordosis or reduce kyphosis of the spine.

In your case, you should report 22206 for the initial level (T10), and 22208 x 2 for the two additional levels (T11 and T12). Because 22208 is a designated add-on code, you will not need to add modifiers to the code.