Neurosurgery Coding Alert

Question: Our surgeon is removing his first X-stop. How do I code that in addition to a decompression with soft fusion?

Iowa Subscriber

Answer: Some coders recommend 22850 (Removal of posterior nonsegmental instrumentation [e.g., Harrington rod]) for X-stop removal, but the American Association of Neurological Surgeons (AANS) recommends 22899 (Unlisted procedure, spine). Because the Xstop is a device between vertebrae whose purpose is to restrict extension but not immobilize the joint, the unlisted code is appropriate.

Report the remaining aspects of the surgery with:

• 22612 -- Arthrodesis, posterior or posterolateral technique, single level; lumbar (with or without lateral transverse technique)

• +20931 -- Allograft for spine surgery only; structural (List separately in addition to code for primary procedure)

• 63047 with modifier 51 -- Laminectomy, facetectomy and foraminotomy (unilateral or  bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [e.g., spinal or lateral recess stenosis], single vertebral segment; lumbar; Multiple procedures

• +63048 -- ... each additional segment, cervical, thoracic, or lumbar (List separately in addition to  code for primary procedure) if the surgeon decompresses additional levels.