Neurosurgery Coding Alert

Question: How should I determine whether a spinal fixation procedure is segmental or non-segmental? Should I base it on how many levels the fixation spans?


Oklahoma Subscriber

Answer: The number of levels spanned doesn't matter for segmental versus non-segmental determination in spinal fixation. The attachment points are what you need to look at to determine which is correct. Two-segment fixation is non-segmental, and anything greater than two is segmental.

Coding scenario: If the neurosurgeon performed a single-level instrumentation (i.e., two adjacent vertebrae), you should assign 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]).

If he performed a two-level (i.e., three-segment) instrumentation attached at L4, L5 and S1, use 22842 (Posterior segmental instrumentation [e.g., pedicle fixation, dual rods with multiple hooks and subliminal wires]; 3 to 6 vertebral segments).  

If he placed the pedicle screws and attached the instrumentation at only two places, 22840 would be correct regardless of how many levels are between the endpoints.

Clinical and coding expertise for You Be the Coder and Reader Questions provided by Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University department of surgery.