CPT defines “segmental instrumentation” as involving “fixation at each end of the construct and at least one additional interposed bony attachment.” Non-segmental instrumentation is defined as “fixation at each end of the construct and may span several vertebral segments without attachment of the intervening segments.” Almost all spinal surgery currently performed involves segmental instrumentation, and non-segmental instrumentation is rarely used.
The CPT codes for instrumentation vary based on whether the procedure was performed with an anterior or posterior approach and how many spinal segments were involved. The counting of segments for these procedures is different from how the counting of the interspaces for the fusions is done. When the discs upon which the surgery is performed are listed in the operative report as C4-5, C5-6 and C6-7, the 22846 code for instrumentation at four vertebral segments would be billed (whereas, only a fusion at three levels would be billed).
Here are the codes for instrumentation:
Anterior instrumentation: 2-3 vertebral segments (code 22845), 4-7 segments (code 22846), eight or more segments (code 22847).
For the removal of posterior non-segmental instrumentation (such as a Harrington Rod), use code 22850.
For removal of posterior segmental instrumentation, use code 22852.
For removal of anterior instrumentation, use code 22855.
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The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
Related Articles on Spine Coding:
Surgery Center Coding Guidance: Posterior/Posterolateral Fusions
Surgery Center Coding Guidance: PLIF and TLIF Procedures
Surgery Center Coding Guidance: Anterior Cervical Diskectomy and Fusion Procedures
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