Neurosurgery Coding Alert
Osteotomy Means Use 22220 for Spur Removal
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? Answer: You should report 22220 (Osteotomy of spine, including diskectomy, anterior approach, single vertebral segment; cervical) for the initial level at C4, and +22226 (... each additional vertebral segment [list separately in addition to code for primary procedure]) for the second-level osteophytectomy (C5).
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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 osteotomy of the anterior spine, which determines the codes you should report.
Report the removal of the anterior instrumentation using 22855 (Removal of anterior instrumentation).
Note: If the neurosurgeon removed part of the actual vertebra in addition to the osteophyte, report 22110 (Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root[s], single vertebral segment; cervical).
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