Neurosurgery Coding Alert

Question: How can we report a posterior spinal fusion from L3 to T7? Our surgeon also did spinal instrumentation. What is the best code for spinal instrumentation for this procedure?

Florida Subscriber

Answer: For the procedure described, you should consider arthrodesis and posterior segmental instrumentation codes. The challenging part is to keep a count of levels. Consider the following procedure codes:

• For arthrodesis of L2-L3: 22612, Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed)
• For arthrodesis at additional levels: 22614 (Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment [List separately in addition to code for primary procedure]) x 7 for T7-T8, T8-T9, T9-T10, T10-T11, T11-T12, T12-L1, and L1-L2.
• For posterior segment instrumentation: 22843, Posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral segments (List separately in addition to code for primary procedure)

However, if only two points of fixation are performed (e.g., T7 and L3 without intervening segments), then one should instead report 22840.