Orthopedic Coding Alert

Question: Our orthopedic surgeon placed two different cervical plates at different spinal levels on a patient's spine. Can I bill +22845 twice with modifier 59 attached?

Texas Subscriber

Answer: If the orthopedic surgeon uses two separate plates on different spinal levels, you can report +22845 (Anterior instrumentation; 2 to 3 vertebral segments [List separately in addition to code for primary procedure]) twice. You should append modifier 59 (Distinct procedural service) to the second listing of +22845.

In some cases, you may have to submit your surgeon's documentation to demonstrate that he used two separate plates. Because +22845's descriptor refers to "2 to 3 vertebral segments," insurers may suspect that your practice erroneously reported two units of +22845 when the surgeon placed a plate that spanned two segments. But you should report this code twice only if the surgeon actually places two separate plates.

Example: The surgeon places a plate that spans from C2 through C4. Levels C5 through L1 are healthy, so the physician does not address them. He then places another plate that spans from L2 through L4. You should report +22845, followed by +22845-59.

Orthopedic surgeons place spinal plates during surgeries such as anterior discectomy and fusion. The plate helps to ensure that the bone graft remains secure and provides extra stability. This can be done in the front f the spine, in which case the physician generally uses a plate system that screws right into the bone.

-- Reader Questions and You Be the Coder were reviewed by Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network LLC; and Bill Mallon, MD, orthopedic surgeon and medical director at Triangle Orthopaedic Associates in Durham, N.C.