Orthopedic Coding Alert

Question: My orthopedist removed posterior hardware at L5-S1 and then decided to do a fusion at L4-L5 with hardware. How should I code this?

Also, if the physician takes the hardware out and puts it back in at the  exact same level, I should use 22849, correct? When the physician is going up one level but still using the holes previously used and adding more, it becomes cloudy for me.

Louisiana Subscriber

Answer: For your first scenario, you should report 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar [with or without lateral transverse technique]), +22840 (Posterior non-segmental  instrumentation [e.g., Harrington rod technique, pedicle fixation across one interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, face screw fixation] [List separately in addition to code for primary procedure]), and 22852-51 (Removal of posterior segmental instrumentation; Multiple procedures).

For your second scenario, you are correct. You should code the removal and reinsertion at the same level with 22849 (Reinsertion of spinal fixation device) only. If the orthopedist removed and included new levels, then you shouldn't report the removal. According to Correct Coding Initiative (CCI) edits, 22849 includes 22852.

Reason: Code 22849 specifies "reinsertion." You can't reinsert a device without having removed a previously inserted device. Therefore, removal (22852) is integral to reinsertion (22849), and you should report only 22849 when the surgeon performs both at the same level.

For your final question, you should report 22612 and 22489-51. This describes the arthrodesis and the removal and reinsertion of the hardware.