Orthopedic Coding Alert

In last month’s issue of Orthopedic Coding Alert, the article “Code Family Matters on Total Disc Arthroplasty” took a look at coding for total disc arthroplasties.

One subject that wasn’t covered was disc removals, which will occur in some arthroplasty patients.

Refresher: When your surgeon performs a total disc arthroplasty, you’ll report the service with one of the following codes, depending on encounter specifics:

• 22856 (Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); single interspace, cervical)
• +22858 (… second level, cervical (List separately in addition to code for primary procedure))
• 22857 (Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression); single interspace, lumbar)
• +22860 (… second interspace, lumbar (List separately in addition to code for primary procedure))

None of these codes bundle disc arthroplasty removal, meaning you can code for any removals your surgeon performs. Read on for more information on reporting arthroplasty removals.

Use These Codes for Removals

There are several reasons the surgeon may have to remove a total disc arthroplasty. The removal could be prompted by “some instability of the spine requiring a surgical fusion. Sometimes you have failure of the disc device requiring a fusion,” according to Kyle S. Nelson, MD, of Metropolitan Neurosurgery, PA in Coon Rapids, Minnesota.

You’ll report total disc arthroplasty removal with the following codes:

• 22864 (Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical)
• +0095T (Removal of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, cervical (List separately in addition to code for primary procedure))
• 22865 (Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar)
• +0164T (Removal of total disc arthroplasty, (artificial disc), anterior approach, each additional interspace, lumbar (List separately in addition to code for primary procedure)).

After removal of the disc arthroplasty, a cervical fusion is performed — and you’ll likely be able to code for it. “Since a concurrent decompression would not typically be necessary having performed it at the time of the initial disc arthroplasty placement, one would typically report 22554 [Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); cervical below C2] for a single-level anterior cervical arthrodesis and +22585 [Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); each additional interspace (List separately in addition to code for primary procedure)] if a two-level disc arthroplasty was removed and converted to a cervical fusion,” according to Gregory Przybylski, MD, immediate past chairman of neuroscience and director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey.

In addition, an interbody device code (+22853 [Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure)]) or structural allograft (+20931 [Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure)]) may be reported along with anterior spinal instrumentation +22845 (Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure)).

Check your notes for encounter specifics to see if these coding combinations are possible and allowable.