Neurosurgery Coding Alert

Question: Which codes should I report if the physician documents "hardware injections in the lumbar spine x 3 screws"?

New Hampshire Subscriber

Answer: You should report one of the following unlisted-procedure codes for your physician's services: 64999 (Unlisted procedure, nervous system), 21899 (Unlisted procedure, neck or thorax) or 22899 (Unlisted procedure, spine).
 
Usually, physicians perform hardware injections to determine whether the "retained" hardware (the screws) is the source of the patient's post-fusion continued pain.
 
During the procedure, the physician will inject a small amount of anesthetic at each screw and may have the patient go through range of motion to see whether the medication takes away the pain.
 
Typically, the surgeons want to make sure that the hardware is causing the problem before they operate to remove it all, only to find that the patient's pain still exists.