Neurosurgery Coding Alert

Question: Our surgeon performed left C7-T1 hemilaminectomies,extradural opening for debulking of the left C7 nerve root tumor, and nerve root exploration. He used C7 and T1 pedicle screw fixation and bone decortication for fusion. How do we code all these procedures?

Tennessee Subscriber

Answer: Start with 63280 (Laminectomy for biopsy/ excision of intraspinal neoplasm; intradural extramedullary, cervical).

Your arthrodesis code will be either 22610 (Arthrodesis, posterior or posterolateral technique, single level; thoracic [with or without lateral transverse technique) or 22600 (Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment).

Lastly, include +22840 (Posterior non-segmental instrumentation [e.g., Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation] [List separately in addition to code for primary procedure]) for the screw fixation.

Assuming the bone removed in the laminectomy is used to stimulate fusion, you can also use 20936 (Autograft for spine surgery only [includes harvesting the graft]; local [e.g., ribs, spinous process, or laminar  fragments] obtained from the same incision [List separately in addition to code for primary procedure]).