These Frequently Asked Questions are provided to assist you with common orthopaedic coding issues. Check back monthly for updated topics.

This Month's Topic:
Instrumentation Removal and Reinsertion

	Our physician performed a revision spine procedure. In the dictation, he indicates that he removed the instrumentation L3, L4, and L5 , performed the revision surgery, placed new pedicle screws at the same level. I am unsure how to report this since CPT says 22849 and 22852 cannot be reported together.
	In the scenario described, the correct code is 22849 Reinsertion of spinal fixation device. This code is reported when the physician removes and replaces instrumentation at the exact same level. The removal is considered to be an integral part of this procedure as the instrumentation cannot be replaced if the old has not been removed.

Coding Corner Archive

Just click on a topic below to view the discussion:

• Coding Existing Problem and New Problem on Same Visit (June 2007)
• "CX-rays and "minimum views" (May 2007)
• CPT Code Usage at the Beginning/End of a Year (January 2007)
• Code for Core Decompression of the Hip (November 2006)
• Hallux Valgus with a Chevron Metatarsal Osteotomy (August 2006)
• Removal and Re-insertion of Spacer (May 2006)
• Posterolateral Fusion L1-L5 (April 2006)
• Modifier 62 (October 2005)
• Coding Arthroscopic Elbow Surgery (July 2005)
• Visit Included in Global Surgical Package or Not? (May 2005)
• Cortizone injections (April 2005)
• Athletic Trainers and Incident-To Physical Therapy (March 2005)
• Coding for Range of Motion, 95851 (February 2005)
• Conscious Sedation—Can I bill or not? Will the payors reimburse me? (January 2005)
• New vs. Established Patient (December 2004)
• Consults vs. IP Admission (November 2004)
• Skeletal Traction Application Prior to Definitive Fracture Management (October 2004)
• NPPS as Assistants at Surgery (September 2004)
• Minimally Invasive Procedures (August 2004)
• Modifier 51 versus 59 (July 2004)
  

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