What’s Included and Excluded in an ALIF

Question:

Hi, I have a spine surgeon and vascular surgeon working together on an ALIF procedure, 2 level, which I have billed 22558/22585. The vascular surgeon is also repairing the sympathetic nerve, which i don't see a code for. He has input 64722 but I'm not quite sure that would be the correct code. Also, would that not be part of the ALIF procedure? He is also starting to bill and code the repair of the middle sacral vein, sacral artery, and iliolumbar vein. I looked at those codes at 35221, now I put those through the NCCI edits, and it seems that it can be billed. However, I read through another coding forum that a provider cant bill those codes, as that is part of the ALIF procedure. I need clarification on whether repairing artery or veins are part of the ALIF procedure.

Answer:

The question you pose is a complicated one without reviewing the operative report, therefore, here are some general guidelines.

If the vascular surgeon is providing the approach and not there to treat a complication during the ALIF procedure, the approach may include access through the the iliac vessels, parasympathetic nerves, and middle sacral artery. If there are incisions through any of these structures, then they are included and would not be billed separately.

*This response is based on the best information available as of 05/07/26.