Neurosurgery Coding Alert

Question: The surgeon performs ACDF at C4-C5 with cage insertion, non-segmental instrumentation, and bone morphogenetic protein (BMP). Encounter notes indicate that the plate and screws (anterior instrumentation) are a separate implant and not components of a standalone interbody device. Which codes should I report on this claim?

Hawaii Subscriber

Answer: You should report the following codes for this scenario:

• 22551 (Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2) for the ACDF.
• +22853 (Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure)) for the cage insertion. Note: You should report +22853 for each treated intervertebral disc space, according to CPT^®.
• +22845 (Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure)) for the non-segmental instrumentation.
• +20930 (Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure)) for the BMP.

Don’t miss: Code 22551 describes an “ACDF” (anterior cervical discectomy and fusion) procedure. This code is used to report anterior interbody arthrodesis and is intended to include discectomy for decompression performed at the same level. The code descriptor contains all the individual services that are inherently included as part of this particular procedure. It is also worth noting that there is an FDA warning about application of BMP for anterior cervical surgery. Published in 2008, the warning addresses the observed occurrences of marked dysphagia, swelling, and/ or the need for intubation/tracheostomy that has resulted in significant patient injuries. The application of BMP in anterior cervical surgery is considered an off-label application associated with increased risk of patient harm.