Neurosurgery Coding Alert

Question: If the surgeon takes out the instrumentation before he performs a repeat fusion, I know we can't charge for spinal instrumentation removal. Does the same rule apply when he removes the instrumentation because the patient's body rejects it and she keeps getting infections?

California Subscriber

Answer: On rare occasions, your surgeon will have to remove spinal instrumentation because the instrumentation breaks, the patient's body rejects it, or the patient requires an adjustment in the type of instrumentation. In these cases, you can code separately for the instrumentation removal.

Here's how: If your physician returns the patient to the operating room during the global surgical period because her body rejects the instrumentation, you should append modifier 78 (Unplanned return to the operating/ procedure room by the same physician following initial procedure for a related procedure during the postoperative period) to the appropriate spinal instrumentation removal code:

• 22850 -- Removal of posterior nonsegmental instrumentation (e.g., Harrington rod)

• 22852 -- Removal of posterior segmental instrumentation

• 22855 -- Removal of anterior instrumentation.