Neurosurgery Coding Alert

Answer: Code 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace [other than for decompression], single interspace; lumbar) specifically includes laminectomy, facetectomy and diskectomy in preparation for a posterior lumbar interbody fusion. You may also report 22851 (Application of intervertebral biomechanical device[s] [e.g., synthetic cage(s), threaded bone dowel(s), methylmethacrylate] to vertebral defect or interspace) if the surgeon places an intervertebral threaded cage. Note that you may report this code only once per interspace, not per device.

If the surgeon performs decompression that goes beyond that involved in the bony removal necessary to carry out the posterior interbody fusion, you may also report 63047-51 (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). Appending modifier -59 (Distinct procedural service) in addition specifies that the surgeon performed the decompression at a different location. By linking a different diagnosis to each procedure (e.g., lumbar stenosis [724.02] with 63047, and lumbar spondylolisthesis [756.12] with 22630) you can further clarify that the physician performed separate procedures.