MAY 2016

Posterior Spinal Arthrodesis

Using what I like to call the 5 Points to Spinal Arthrodesis, let’s review the coding for a posterior spinal fusion. The types of services that can be reported are;

  1. Arthrodesis technique - approach (anterior interbody, posterior interbody, posterior or posterolateral technique)
  2. Decompression (corpectomy, laminotomy, laminectomy, facetectomy, foraminotomy, discectomy)
  3. Insertion of biomechanical devices (synthetic cages)
  4. Insertion of bone graft (autograft, allograft, structural, morselized, localized, through same or separate incision)
  5. Instrumentation (plates, screws, rods - segmental, non-segmental)

Using fluoroscopic guidance skin incision was made at L5-S1 and carried down to the fascia. Next a pars defect was identified at L5 bilaterally with mobile lamina and pars. The fibrous tissue was freed up and removed and complete laminectomy and Gill procedure was performed fully decompressing the exiting nerve roots. Once this was done a radical discectomy was completed bilaterally then after distraction dramatic improvement of the spondylolisthesis was able to be achieved. Endplates were prepared and bilateral lordotic PEEK cages were then placed as well as laminar autograft and Osteocel , pedicle screws were then placed a L5-S1 using AP and lateral fluoroscopic guidance and connected to the NuVasive pedicle screw rod system with all screws appropriately tightened. Posterolateral fusion was achieved after lateral decortication by placing the remaining autograft/allograft mixture. The wound was then closed, Experal was injected for postoperative analgesia and sterile dressing was applied.

  1. Arthrodesis Technique – 22633 combined posterior or posterolateral technique with posterior interbody technique. You can see in the op note above that PEEK cages were placed in the vertebral interspace which would represent the interbody technique and also a posterolateral technique by placement of bone graft along the lateral decorticated surfaces. That’s what makes this a combined technique.
  2. Decompression – this patient had a spondylolisthesis diagnosis and a Gill procedure was performed. This codes to 63012-59 laminectomy for spondylolisthesis. Many of the decompression codes bundle into the spinal arthrodesis codes so you may need to take CCI edits into consideration when reporting these procedures to specific carriers.
  3. Insertion of biomechanical devices - 2 PEEK cages were inserted so it would be appropriate to report 22851 one time. CPT Assistant Sep. 97 states that 22851 can only be reported one time regardless if one or more cages are place at the same intervertebral level, but if cages are placed at two different levels, then 22851 can be reported multiple times.
  4. Insertion of bone graft – the laminar autograft would be bone that was taken during the decompression procedure and reported with 20936 autograft for spine surgery, local obtained from same incision and Osteocel 20930 osteopromotive material.
  5. Instrumentation – 22840 for posterior non-segmental instrumentation is represented by the Nuvasive pedicle screw/rod system.







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