Neurosurgery Coding Alert

Question: A patient with difficulty swallowing presented to our practice. The neurosurgeon performed surgery, removing a C5-C6 plate and completing a C4-C5 resection of an anterior osteophytic spur. I don't see a code for the resection, so what is the best code to report this?

South Carolina Subscriber

Answer: You won't find a precise code to describe the uncommon circumstance of anterior osteophyte resection for swallowing difficulties. Although an unlisted code 64999 (Unlisted procedure, nervous system) is the best way to describe this, you may consider reporting 22110 (Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root[s], single vertebral segment; cervical) for the inferior C4 osteophyte and 22116 ( ... each additional vertebral segment [List separately in addition to code for primary procedure]) for the second-level osteophytectomy.

Although the detailed clinical description for this code does not outline the definition of bony lesion, the intent of these codes describes the excision of an intrinsic vertebral lesion rather than an overgrowth of the arthritic hypertrophic margins of the vertebral body.

Catch this: Osteophytes are bony growths (calcific spurs) that grow on normal bone, often causing displacement of surrounding tissues and causing the symptoms reported. To remove these spurs from the anterior spine, a neurosurgeon would perform an osteophyte resection of the anterior spine without entering the disc space, which determines the most appropriate codes that you should report.

 Report the removal of the anterior instrumentation using 22855 (Removal of anterior instrumentation).

-- Technical and coding guidance for You Be the Coder and Reader Questions provided by Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison.