Neurosurgery Coding Alert

Question:

Maine Subscriber

If the surgeon removed the screws but didn't insert new ones, you have two coding choices depending on the original procedure. Code with 22852 (Removal of posterior segmental  instrumentation) if the iliac screws were part of a previous lumbar-spinal fusion. If the iliac screws were for an old pelvic fracture, your most likely choice is 20680 (Removal of implant; deep [e.g., buried wire, pin, screw, metal band, nail, rod or plate]). Append modifier 52 (Reduced services) to the procedure code to indicate the surgeon didn't remove all instrumentation.

If, however, the surgeon inserted new screws, report 22849 (Reinsertion of spinal fixation device). No modifiers or other codes are necessary.

Explanation: Surgeons sometimes use iliac screws during spinal fusion cases to anchor or attach plates or rods going up to the lumbar spine. CPT includes specific codes for spinal instrumentation insertion and removal and your example definitely involves deep hardware. Because of this, you would report 22852 for the case in question instead of 20680.