Q. My surgeon removed old screws and rods at L2-L3. He then performed a new posterolateral fusion where he inserted new screws and rods at L2, L3, and L4 during the same operation. Should we code this as replacement of spinal hardware (CPT 22849)? Is the removal of the old screws and rods coded separately with CPT 22850?
A. Actually, in this case, you would report the new instrumentation code 22842 only. We would select this code since the approach is posterior (instrumentation placed during a posterolateral fusion), and hardware is segmental and spanning 3 segments (L2, L3, and L4). If you need additional information on how to determine if hardware is segmental or non-segmental, you can check out a recent article on that topic here: https://codingmastery.com/2021/09/28/segmental-vs-non-segmental-spinal-instrumentation-cpt-codes-22840-22848/.
To explain why we would code only the new insertion code, CPT 22849 for reinsertion of a spinal fixation device is reported when the exact same hardware is removed and replaced at the same levels (e.g., broken screw is removed at L2, and a new screw is inserted at L2).1 In this scenario, though, screws and rods are removed at L2-L3 and then new screws and rods are placed at L2, L3, and L4. L4 was not included in the original surgery so this is an extension of that original hardware. For that reason, this is not a true reinsertion as defined in CPT 22849.
Regarding the hardware removal, in addition to having NCCI edits that bundle CPT 22850 to 22842 and other new instrumentation codes, the CPT manual states this: “Only the appropriate insertion code (22840-22848) should be reported when previously placed spinal instrumentation is being removed or revised during the same session where new instrumentation is inserted at levels including all or part of the previously instrumented segments. Do not report the reinsertion (22849) or removal (22850, 22852, 22855) procedures in addition to the insertion of the new instrumentation (22840-22848).”2 Because the new instrumentation is inserted at L2 and L3 which were included in the previously instrumented segments and then extended to L4 as well, following this guideline, we will code only CPT 22842.
1 – CPT Assistant, June 2017, copyright American Medical Association
2 – CPT Professional 2021, copyright American Medical Association, 2020
