Neurosurgery Coding Alert

Question: Our surgeon placed hardware at T3 and T4 and also at L3 and L4, with no fixation between them. Should I report this as 22842 or 22844? Kentucky Subscriber Answer: Because the neurosurgeon fixes nonsegmental instrumentation at two distant locations, the appropriate coding depends on whether the rod connects the two sites (T3-T4 to L3-L4). If a rod does connect between the two sites, you should report 22844 (Posterior segmental instrumentation [e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires]; 13 or more vertebral segments). If the rod is only between T3-T4 with a separate and unattached rod to L3-L4, you would instead report 22840 (Posterior nonsegmental instrumentation [e.g., Harrington rod technique, pedicle fixation across one interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation]) for the first location and 22840-59 (Distinct procedural service) for the second location. -- 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.