Facet Wedge?

Question:

Our surgeon used a facet wedge device at C1-C2 and then performed facet arthrodesis with instrumentation. How would I code the facet wedge?

Answer:

Thank you for contacting KZA with an inquiry!

The codes for posterior intrafacet implants (facet wedge/dowel arthrodesis) are Category III codes: 0219T (Cervical, 0220T (Thoracic), & 0221T (Lumbar). These codes include imaging and placement of bone grafts, synthetic devices, and arthrodesis.

Based on the presented scenario, if a facet fusion is performed and documented, it would not be appropriate to report 22600 instead of or in addition to 0219T. CPT provides a list of codes not to report in conjunction with at the same level. This is appropriately reported with 0219T.

*This response is based on the best information available as of 7/03/25.

Amount of Lamina Removed for a Laminectomy

Question:

I'm pretty new to neurosurgery coding and could use some help. Is there a specific amount or percentage of lamina that must be removed in order to code 63047?

Answer:

No. Surgeons usually try to remove as little lamina as possible – just enough to relieve pressure on the nerve. A specific amount does not need to be documented.

*This response is based on the best information available as of 6/19/25.

Instrumentation Removal vs. Exploration

Question:

My coder told me that if spinal instrumentation is removed and exploration performed but nothing else done, we would code for exploration but not for the removal of instrumentation.   Why wouldn't we bill instrumentation removal vs exploration?

Answer:

When spinal instrumentation is removed for the purpose of exploration, we would code the exploration CPT code 22830; the instrumentation removal is included in the exploration. 

*This response is based on the best information available as of 6/05/25.

Thoracic Calcified Disc

Question:

The documentation indicates a costovertebral approach and rib removal to access and dissect a calcified thoracic disc at T9-T10. How is this coded? And can the rib removal be reported separately?

Answer:

This is most likely coded as 63064, Costovertebral approach with decompression of spinal cord or nerve root(s) (eg, herniated intervertebral disc), thoracic; single segment. The rib removal is included. A costotranversectomy for the rib removal, is included and not separately reported.

*This response is based on the best information available as of 5/22/25.

Costotransversectomy Included in Transthoracic Corpectomy

Question:

Is a costotransversectomy included with transthoracic corpectomies?

Answer:

Yes.  A costotransversectomy involves removing a rib or ribs for a thoracic approach to the spine and is always included as part of the approach in a transthoracic corpectomy. 

*This response is based on the best information available as of 5/8/25.

Documentation to Support Modifier 22

Question:

When performing spinal procedures, does documentation of obesity support the use of modifier 22?

Answer:

Documentation of obesity alone does not support the use of modifier 22, however, additional information indicating the patient’s obesity resulted in a procedure that was technically more difficult, or required more time than normal (i.e., suggesting that the neck was thick, positioning was difficult, more time was spent), could support the use of modifier 22.

*This response is based on the best information available as of 4/24/25.