Neurosurgery Coding Alert

Question: Our neurosurgeon has scheduled exploratory surgery because he believes the patient's Ray Cage from PLIF has loosened and moved. He expects to either secure or remove the cage and possibly replace it with additional allografts. He suggested I code with 22849, 22830, and +20931. Are these an appropriate starting point (depending on the final procedure) and can 22849 be used for cage reinsertion?

Virginia Subscriber

Answer: It's difficult to give advice before the procedure is complete, but parts of your physician's inclination might be on track.

Code 22830 (Exploration of spinal fusion) is appropriate, but will probably be denied as considered bundled with instrumentation revision codes by Medicare. Code 22849 (Reinsertion of spinal fixation device) might be appropriate if that's the service your physician performs. Code +20931 (Allograft for spine surgery only; structural [List separately in addition to code for primary procedure]) may be used as an alternative/replacement to the cage removal. Verify the type of graft used (allograft versus autograft and structural versus morselized) to narrow your choices. If your surgeon does not place a replacement prosthetic cage, you'll choose a code for removal of instrumentation instead of 22849.

Graft note: If your surgeon also harvested a graft, this indicates that he likely performed repeat fusion for pseudoarthrosis. If so, report an arthrodesis code in addition to the other procedures.