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Neurosurgery Coding Alert

Reader Questions:

Draw the Line Between Segmental, Nonsegmental

Published on Tue Jan 27, 2009

Question: How can I determine segmental from nonsegmental spinal instrumentation? North Dakota Subscriber Answer: For posterior instrumentation to determine if the device is segmental (+22842-+22844) or nonsegmental (+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 ...), count the number of fixation points: - If the surgeon attaches the instrumentation to the spine at only two points, the device is nonsegmental (regardless of the number of vertebrae spanned). - If the surgeon attaches the device to at least three points (on three different segments), the instrumentation is segmental. In some cases, the surgeon will place a metal cage or other prosthetic device for stabilization in an area where he has removed a large portion of the vertebra. This represents a third type of instrumentation, which you should report using +22851 (Application of intervertebral biomechanical device[s] [...]
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