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removal and reinsertion of pedicle screw fixation

Cari Posted Tue 15th of May, 2012 18:55:06 PM

Dr. performed removal of old instrumentation at L4-S1 and new pedicle screw fixation L3-L4. Can we bill for 22850 and 22840?

SuperCoder Answered Tue 15th of May, 2012 19:47:27 PM

New instructions under the Spinal Instrumentation subsection have been revised and broken down into three categories:

•Removal (22850, 22852, 22855): use when taking out hardware and not when insertion or reinsertion is performed
•Reinsertion (22849): use when hardware is going back in at the same levels/location (i.e., failed hardware) and includes removal (22850, 22852, 22855)
•Insertion (22840-22848): use when new hardware is put in which "exceeds" the previously placed hardware and includes removal (22850, 22852, 22855)

In your case insertion and removal is at different levels, hence 22850 and 22840 is appropriate.

Cari Posted Fri 01st of June, 2012 13:37:00 PM

Thank you. Even if reinsertion is not at the same levels, but same general location?

SuperCoder Answered Fri 01st of June, 2012 19:34:29 PM

Code 22849 specifies -reinsertion.- You can't reinsert a device without having removed a previously inserted device. Therefore removal (22852) is integral to reinsertion (22849), and you should report only 22849 when the surgeon performs both at the same level.

Code 22850 is a column 2 code for 22840 , but a modifier is allowed in order to differentiate between the services provided.
*Use modifier with code 22850

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