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Dome Osteotomy & Discectomy L5-S1

Nicole Posted Mon 14th of November, 2016 11:38:31 AM
The doctor did the following: Under fluoroscopy (77003), L4-5 TLIF (22633), Placement of PEEK cage L4-5 (22851), Allograft (20931), Pedicle screws were placed at L4, L5, S1 (22842). Laminectomy was done L4-S1 (63047 for L5-S1, since the level at L4-5 is inclusive to the TLIF) Because of the nature of the slippage, a DOME OSTEOTOMY was performed at L5-S1. Bilateral discectomy was performed at L5-S1 in order to reduce any disc material. Reducers were used to reduce the L5-S1 slip under fluoroscopic visualization. What would the DOME OSTEOTOMY and DISCECTOMY at the L5-S1 level be coded? Possible 22214/22216?
SuperCoder Answered Tue 15th of November, 2016 07:06:27 AM


As per the above documentation, to code for osteotomy, we need to look at the spinal approach made to perform the procedure either on one column osteotomy of the spine or three-column osteotomy.

Kindly find the below CPT codes, basis the spinal approach.  

Posterior or posterolateral approach

A). 3 columns, 1 vertebral segment; lumbar

CPT code 22207 and 22208 (each additional vertebral segment).

B). 1 vertebral segment; lumbar

CPT code 22214 and 22216 (each additional vertebral segment).

Anterior approach

CPT code 22224 and 22226 (each additional vertebral segment).

Thank you.

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