Q&A: CPT coding for a segmental spinal fusion with pedicle screws

Q: I recently received guidance regarding CPT coding for a segmental spinal fusion procedure with pedicle screws placed at the L3 and L4 vertebrae. I was instructed to report CPT code 22612 (arthrodesis, posterior or posterolateral technique, single level; lumbar [with lateral transverse technique, when performed]) for the fusion procedure. However, I believe it would be appropriate to also report add-on code 22614 (arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment) for the additional segment fused.

A: You should report CPT code 22612 for the spinal fusion. It would not be appropriate to report add-on code 22614 for a fusion performed only at the L3-L4 level.

While it is true that pedicle screws were placed in the L3 and L4 vertebral bodies, the purpose of this technique was to fuse the two vertebral bodies together. This can be a confusing concept because of the way the code descriptions are written, with the terms “interspace” and “vertebral segment” used interchangeably.

Physicians performing this procedure must look past the confusing terminology to the actual anatomy of the vertebral bodies and their corresponding disc space. As pointed out in the American Academy of Orthopedic Surgeons (AAOS) Bulletin for August 2004:

Fusing a single level technically includes two vertebrae and the intercalary disc. A single vertebra cannot be fused to itself.

When you add another vertebral segment (add-on code 22614), AAOS explains, this “requires the crossing of an interspace.” Therefore, it would only be appropriate to report CPT code 22612 with add-on code 22614 for a fusion involving three total segments and two interspaces (e.g., L3-L4 and L4-L5).

Editor’s note: Margie Scalley Vaught, CPC, CPC-H, CCS-P, MCS-P, ACS-EM, ACS-OR, is a healthcare consultant in Chehalis, Washington. She will be speaking on correct coding for spine surgeries at the 2018 Advanced Specialty Coding, Compliance & Reimbursement Symposium from October 15-17 in Orlando.  

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

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