Coding spinal arthrodesis procedures

Before coding spinal arthrodesis procedures also called as spinal fusion, one must understand the actual procedures that the physician does. Lets have a look at the procedures involved in spinal fusion or arthrodesis.

The physician first performs spinal fusion either by anterior, posterior, or transverse method. One the fusion of vertebra is accomplished, the physician may perform insertion of intervertebral biomechanical devices like synthetic cages or methylmethacrylate. This will require the use of bone grafts for better fixation of the intervertebral devices. The physician may also take a bone marrow aspirate and and mix it with bone grafts before applying them. The bone grafts can be taken either from the same incision or through a separate incision else the physician may also prefer to use premanufactured bonegrafts called as allografts. Before placing the intervertebral cages the physican performs partial or medial laminectomy, diskectomy, and or foraminotomy to prepare the interspace. Once the cages are fixed, the physician performs spinal instrumentation.

CPT codes for arthrodesis and fusion: 22548-22812
CPT codes for application of spinal instrumentation: 22840-22855
CPT codes for spinal bone graft: 20930-20938
CPT codes for partial laminectomy with diskectomty posterior approach: 63020-63035
CPT codes for partial laminectomy with diskectomty anterior approach: 63075-63078

CPT codes for bone grafts, intervertebral cages, and spinal instrumentation are addon codes and are exempt from 51 modifier.

Autografts are grafts taken from the same patient.
Allografts are grafts taken from same species usually from cadavers.
Morselized bone grafts are small pieces or bone powder.
Structural bone graft is a single bone piece.

If the same type of graft is used more than only then only one code should represent it.