We have a new spine physician and are a bit confused about the CPT codes that include the term “segment” in them. We are unsure how to count levels of fusion when he dictates a posterolateral fusion L1-L5.  How do I know how to count the number of levels fused?

The terminology is a little confusing, so you are right to question exactly how to code these cases. In order to perform a fusion you must have two segments to fuse together. You will note in the definition of CPT code 22612, the code reads, single level, not single segment, “Arthrodesis, posterior or posterolateral technique, single level; lumbar (with or without lateral transverse technique)”
In your scenario the physician would code this as follows:

22612 Fusion L1-L2  single level fusion.
22614 Additional segment fusion L2-3 (L3 is the additional segment)
22614 Additional segment fusion L3-4 (L4 is the additional segment)
22614 Additional segment fusion L4-L5 (L5 is the additional segment)

Mary LeGrand, RN, MA, CCS-P, CPC
KarenZupko & Associates, Inc.