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. Lastly, what happens if he takes out hardware at L4-S1 and does fusion at L5-S1 but not at L4-5? (In other words, he replaced hardware and refused at L4-5 only.) What codes should I use then? 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 [...]