Orthopedic Coding Alert

Question: I have this very barebones operative report from one of our surgeons. Here’s what I have:

Procedures

• L3 pedicle subtraction (3 column) osteotomy
• Posterior segmental instrumentation from T12-S1
• Posterior arthrodesis L23
• Exploration of fusion T11-L2 and L3-S1
• Intraoperative O-arm spin for navigation
• Morselized iliac autograft and allograft
• I’m wondering if you can help me make sense of it

Pennsylvania Subscriber

Answer: Coders are trained never to code solely on the procedure statement. In order to provide the most accurate codes, we would new to review the procedure description.

So go back to the procedure description before choosing your final codes. To point you in the right direction, coding for this list could look like this:

• 22207 (Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/ vertebral body subtraction); lumbar) for the L3 pedicle subtraction osteotomy
• Modifier 51 (Multiple procedures) appended to 22207 to indicate multiple procedures
• +22843 (Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral segments (List separately in addition to code for primary procedure)) for the posterior segmental instrumentation from T12-S1
• 22612 (Arthrodesis, posterior or posterolateral technique, single interspace; lumbar (with lateral transverse technique, when performed)) for the posterior arthrodesis from L2-L3
• 22830 (Exploration of spinal fusion) for the exploration of fusion T11-L2 and L3-S1
• Modifier 51 appended to 22830 to indicate multiple procedures
• +61783 (Stereotactic computer-assisted (navigational) procedure; spinal (List separately in addition to code for primary procedure)) for the intraoperative O-arm spin for navigation and confirmation
• 20930 (Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure)) for the morselized autograft
• +20937 (Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or fascial incision) (List separately in addition to code for primary procedure)) for the morselized allograft

Potential exceptions: There are a pair of circumstances that could occur in the above scenario that could change your coding:

• If the spinal instrumentation included the original T11-S1 levels, then 22849 (Reinsertion of spinal fixation device) with modifier 51 appended would be reported rather than +22843.
• If there is a solid fusion T11-S1, one should only be reporting the posterior fusion where the osteotomy is performed (i.e., L23).

While CPT^® allows separate reporting of exploration of fusion from spinal instrumentation (insertion or reinsertion) and arthrodesis (performed at a site different from the exploration), some payers only allow reporting of exploration of fusion when performed in isolation, without concurrent reporting of spinal instrumentation or arthrodesis.