Neurosurgery Coding Alert

Question: Our neurosurgeon treated a patient who had a spinal metastatic cancer diagnosis. The physician performed a T6-T7 bilateral laminectomy with decompression and a T7 lateral extracavitary corpectomy. He also performed T6-T8 interbody fusion with methylmethacrylate. Can we bill 22851 for methylmethacrylate mixture when creating a fusion mass without any cages and/or device spacers being used at the same time?
 Also, on another note, is it OK in some cases to report 22851 for BMP?

Delaware Subscriber


Answer: You can 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 physician uses the methylmethacrylate mixture when creating a fusion mass. However, insurers may question whether the polymethyl methacrylate (PMMA) placement was a true -fusion- in the interbody space (versus corpectomy alone), since fusion will not happen over time. 

Therefore, without viewing the operative note, it is difficult to determine whether your physician performed the requirements to report 22851 for his PMMA.

As for BMP (bone morphogenetic proteins), you should not report 22851 for this service. BMP is a special growth factor for the induction of new bone formation. Surgeons mix this product with allograft or autograft bone used during fusion, for instance.

Most coding experts recommend reporting 20930 (Allograft for spine surgery only; morselized) when the surgeon uses BMP.