Neurosurgery Coding Alert

Question: Our neurosurgeon performed the following procedures:

1) Direct lateral L4-L5 diskectomy through an extracavitary lateral approach, interbody fusion L4-L5 with structural PEEK implant.

2) Posterior pedicle screw nonsegmental instrumentation L4-L5 and posterolateral fusion L4-L5.

3) Intraoperative utilization of neuromonitoring of lumbar plexus with Biotronic neuromonitoring and intraoperataive O-arm fluoroscopy, Stealth navigation utilization imaging for placement of the pedicle screws.

The neuromonitoring/stealth navigation is documented in the surgeon's operative note; there was an additional Operative Monitoring Report by a separate technologist. Does the surgeon have to read/monitor the computer as well as perform the probe placement in order to code for this add-on code? Or is this a procedure reported/billed by the technologist? How do I report this procedure?

Nebraska Subscriber

Answer: While you may report +61783 (Stereotactic computer-assisted [navigational] procedure; spinal [List separately in addition to code for primary procedure]) for the stealth navigation using imaging for screw placement, the neuromonitoring is not reportable by the operating surgeon. Although the scenario describes a "direct lateral approach," the lateral extracavitary approach entails a posterior rather than lateral incision.

As described, the procedure likely represents an anterior retroperitoneal lumbar interbody fusion 22558 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression]; lumbar).

The interbody prosthetic device is described with +22851 (Application of intervertebral biomechanical device[s] [eg, synthetic cage[s], methylmethacrylate] to vertebral defect or interspace [List separately in addition to code for primary procedure]), whereas you would report the posterior lumbar arthrodesis with 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar [with or without lateral transverse technique]) -51 (Multiple procedures:...) and the non-segmental instrumentation with +22840 (Posterior non-segmental instrumentation [eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation] [List separately in addition to code for primary procedure]).