Neurosurgery Coding Alert

Nonsegmental posterior instrumentation attaches to the spine at two points--the proximal and distal portions (top and bottom) of the rod or other device--with no attachment to any vertebrae between those points.

Example: A rod spanning from the first to fifth lumbar levels is attached to the spine at L1 and L5 but would not be attached at L2, L3 or L4.

You may report nonsegmental posterior instrumentation placement using 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]).

Segmental posterior instrumentation attaches to the spine at three or more points, including the proximal and distal portions of the rod or other device.

For instance: A rod spanning from the third cervical to third thoracic vertebra is attached at C3 and T3 but is also attached to at least one other segment between those two points (for example, C6-C7).

You may describe segmental posterior instrumentation placement using 22842 (Posterior segmental instrumentation [e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires]; 3 to 6 vertebral segments), 22843 (- 7 to 12 vertebral segments) and 22844 (- 13 or more vertebral segments), as determined by the number of vertebral segments spanned.