Coding Percutaneous Rods and Screws: Part 2

Question:

What if we the neurosurgeon places percutaneous screws and rods (no posterior fusion/bone graft) as the sole treatment for a vertebral fracture. Do we code the regular posterior instrumentation codes, for example +22840 or +22842?

Answer:

Unfortunately, no. Placement of percutaneous screws and rods as the sole procedure must be reported with an unlisted code (22899, Unlisted procedure, spine).

The posterior instrumentation codes (+22840-+22843) are add-on codes and can only be reported with an applicable primary or parent procedure code. Therefore, in this scenario, only the unlisted code may be reported.

*This response is based on the best information available as of 10/19/23.

Coding percutaneous rods and screws: Part 1

Question:

What if we do the surgeon does an ALIF, 22558 on one day then the second day the only procedure is placing a percutaneous screws and rods (no posterior fusion/bone graft).  Do we bill +22840-58 on the second day?

Answer:

Placement of percutaneous screws and rods is reported using the usual posterior instrumentation codes. However, when there is no applicable primary procedure code such as in this case then you’ll have to use an unlisted code for the procedure (22899 Unlisted procedure, spine).

*This response is based on the best information available as of 10/5/23.

Placement of Percutaneous Posterior Instrumentation (Rod and Screws) Part 2

Question:

I placed posterior percutaneous screws and rods without an arthrodesis. I know I have to use an unlisted code, 22899. How should I price it?

Answer:

Good question. Let’s assume you’re doing +22842 (posterior instrumentation, 3-6 segments) which is an add-on code. Add-on codes are valued for only the intra-operative portion of the service and do not include any value for pre-op (e.g., H&P, discussion with patient), certain intra-operative work (e.g., incision, closure) or post-op work.

Therefore, we recommend you double your fee for +22842 to achieve your fee for the unlisted code. For example, if your fee for +22842 is $100 then your fee for the unlisted code would be $200.

*This response is based on the best information available as of 08/03/23.

Placement of Percutaneous Posterior Instrumentation (Rod and Screws) Part 1

Question:

I placed posterior percutaneous screws and rods without an arthrodesis, the day after an ALIF. Should I bill 22842, it was segmental, 3-6 segments spanned, and a 58 modifier?

Answer:

Code 22842 is for open segmental instrumentation. Most importantly, it is an add-on code and can only be reported with a parent or primary code, such as the ALIF code 22558. Without a primary code, the percutaneous placement of rods and screws must be reported with an unlisted code 22899.

*This response is based on the best information available as of 07/20/23.

Codes for Laminectomy for Lumbar Radiculopathy

Question:

For a patient with a diagnosis of lumbar  radiculopathy, the surgeon performed a L3-L4 laminectomy with bilateral   foraminotomy. She also removed some disc at the same level. Can both 63047 and 63030-59 be billed?

Answer:

For a laminectomy at a single interspace/motion segment, only one code may be reported. In the case described above, the laminectomy for stenosis, 63047, is the only code reported. The disc removal is inclusive. And remember, laminectomy codes are diagnosis driven. A more specific diagnosis for the cause of the radiculopathy stenosis for example, should be added.

*This response is based on the best information available as of 07/06/23.

Venous Stenting for Intracranial Hypertension (ICH)

Question:

What are the most appropriate codes for venous stenting for a patient with intracranial hypertension?

Answer:

There is no specific CPT code for intracranial venous stenting. An unlisted code 64999 should be reported in addition to second order venous catheterization, 36012 and the venogram , most typically 75870, venography superior sagittal sinus. It is not appropriate to report a peripheral stenting code such as 37236. for an intracranial procedure. Code 61635 is also not appropriate as it is specifically for intracranial arterial stenting for a diagnosis of atherosclerosis.

*This response is based on the best information available as of 06/08/23.