Question: I have a question about coding guidance I received recently on coding a fusion procedure with pedicle screws placed at L3 and L4. The code solution recommended fusion code 22612 be reported for the procedure. I believe it would be appropriate to also report add-on code 22614 for the additional segment fused. I would appreciate any correction in my thinking for this coding example. This is a segmental fusion, not an interspace fusion, so wouldn’t it be appropriate to report both codes?
Answer: No, it would not be appropriate to also report 22614 for a fusion done only at the L3/4 level. While it is true that pedicle screws were placed in the L3 and L4 vertebral bodies, the purpose was to fuse the two vertebral bodies at L3/L4 together. This can be a confusing concept because of the way the code descriptions are written, with the terms “interspace” and “vertebral segment” alternately used.
For example, code 22612 describes “arthrodesis, posterior or posterolateral technique, single level, lumbar,” but its add-on code, 22614, states that it reports “each additional vertebral segment.” Practices must look past the confusing terms to the actual anatomy of the vertebral bodies and their corresponding disc space. As pointed out in the American Academy of Orthopaedic Surgeons (AAOS) Bulletin for August 2004: “Fusing a single level technically includes two vertebrae and the intercalary disc. A single vertebra cannot be fused to itself.”
But when you add another vertebral segment (22614), AAOS explains, that “requires the crossing of an interspace.” So when you report both 22612 and 22614, you are describing a fusion involving three total segments and two interspaces (e.g., L3/4 and L4/5).
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