Orthopedic Coding Alert

Question: Our spine surgeon removed instrumentation from L4-S1 and then placed new instrumentation at L3-4. Are we correct in reporting code 22840 (Posterior non-segmental instrumentation [e.g., 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])?

New Jersey Subscriber

Answer: You report code 22840 for this replacement of instrumentation that your surgeon is doing. You will be most appropriate to report spinal instrumentation insertion code when a previously placed spinal instrumentation device is removed or changed during the same session as new instrumentation, even if the insertion includes new levels and/or is part of the previously instrumented segments.

Tip: You should not report reinsertion code 22849 (Reinsertion of spinal fixation device) and/or removal code 22850 (Removal of posterior nonsegmental instrumentation [e.g., Harrington rod]) along with the codes for the insertion of new instrumentation, 22840-22848 (Pelvic fixation [attachment of caudal end of instrumentation to pelvic bony structures] other than sacrum [List separately in addition to code for primary procedure]).