Neurosurgery Coding Alert

Question: The office of our co-surgeon is requesting codes for ALIF. We provided code 22558-62, explaining that our surgeon only assisted with the approach and this was verified in the co-surgeon's dictation. Our surgeon listed our AS, so we can assume that our AS helped with the rest of the procedure. Can we bill the following for the surgeon and AS?

Surgeon: 22558 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression]; lumbar) -62 (Two surgeons), 22845 (Anterior instrumentation; 2 to 3 vertebral segments [List separately in addition to code for primary procedure]), 22851 (Application of intervertebral biomechanical device[s] [e.g., synthetic cage(s), methylmethacrylate] to vertebral defect or interspace [List separately in addition to code for primary procedure]).

Assistant surgeon: 22845, 22851.

New York Subscriber

Answer: The scenario described is quite common. Coding rules allow for co-surgeons to share the work of one procedure, while an assistant surgeon or physician extended (PA or NP) can assistant one of the primary surgeons on one or more additional codes. If the assistant helped the spine surgeon with the instrumentation and interbody device, this may be reported with the 22845 and 22851 codes, appended with the appropriate modifier (-80 for assistant surgeon and -AS for PA/NP assistants).