SRS Newsletter
September 2013
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Spinal Instrumentation Coding for Insertion and Removal

R. Dale Blasier, MD, FRCS(C), MBA
Coding Committee Chair

R. Dale Blasier, MD, FRCS(C), MBA

There are several CPT Codes which involve removal of hardware. These include:

  1. 22849 - Reinsertion of spinal fixation device
  2. 22850 - Removal Posterior non-segmental instrumentation
  3. 22852 - Removal Segmental posterior instrumentation
  4. 22855 - Removal Anterior instrumentation

Recently CPT has issued new explanatory language for these codes:  

“Codes 22849, 22850, 22852, and 22855 are subject to modifier 51 if reported with other definitive procedure(s), including arthrodesis, decompression, and exploration of fusion. Code 22849 should not be reported in conjunction with 22850, 22852, and 22855 at the same spinal levels.

Only the appropriate insertion code (22840 -22848) should be reported when previously placed spinal instrumentation is  being removed or revised during the same session where new instrumentation is inserted  at levels including all or part of the previously instrumented segments.

Do not report the reinsertion (22849) or removal (22850, 22852, and 22855) procedures in addition to the insertion of the new instrumentation (22840-22848).”
The guidelines also specify that reinsertion (22849) and/or removal (22850) should not be additionally reported with insertion of new instrumentation (22840-22848). Instead, the intent is that when insertion of instrumentation is performed that involves the original levels as well as new levels, only the appropriate code for the type of instrumentation (anterior or posterior) should be used according to the level(s) of instrumentation performed for the procedure.

In other words:

The removal codes (22850, 22852, and 22855) should be used when taking out hardware is all that is being done and not used when insertion or reinsertion is performed.

The reinsertion code (22849) should be used when hardware is going back in at the same levels/location (i.e. for failed hardware, nonunion, etc.). Reinsertion includes removal (22850, 22852, and 22855).

The insertion codes (22840-22848) are used when new hardware is put in which “exceeds” the previously placed hardware. The insertion codes include removal (22850, 22852, and 22855).

Committee Chair: R. Dale Blaiser, MD Committee Members: Jeffrey B. Neustadt, MD; Neel Anand, MD; Christopher J. DeWald, MD; Michael P. Chapman, MD; Mathew D. Hepler, MD; Nigel J. Price, MD.