Neurosurgery Coding Alert

Question: Our neurosurgeon placed PEEK interbody spacers after discectomy and filled the intervertebral space with 1cc of Osteo-Cell. He then placed a cervical plate across the fusion construct. He says we can report a separate instrumentation code for the plate, but I'm not sure. What's the correct coding?

Illinois Subscriber

Answer: If the surgeon placed plating and screws for instrumentation after placing the PEEK cage/spacer, then you can code for both parts of the procedure. Here's how:

+22851 (Application of intervertebral biomechanical device[s] [e.g., synthetic cage{s}, threaded bone dowell{s}, methylmethacrylate] to vertebral defect or interspace [List separately in addition to code for primary procedure]) for the PEEK device used for interspace fusion

+20930 (Allograft for spine surgery only; morselized [List separately in addition to code for primary procedure]) for the Osteo-Cell synthetic bone protein injection

+22845 (Anterior instrumentation; 2 to 3 vertebral segments [List separately in addition to code for primary procedure]) for the cervical fixation plate.

Remember: You'll also report the appropriate codes for discectomy as the primary procedure and arthrodesis as the second procedure appended by the 51 modifier (Multiple procedures), then add these to the claim.