Spine Coding Help

I'm new to spine surgery and hoping for some help. I keep getting confused with interbody fusion coding. If a provider plans to do a combined interbody fusion (22633) but once in the OR decides the interbody would be too dangerous to the patient can that code still be billed?

Here is an excerpt from the op note:
I then proceeded to perform a transforaminal lumbar interbody fusion at
L5-S1 with a modified Wiltse type approach.  Also, decompression was
carried by performing a partial laminectomy, facetectomy and
foraminotomy.  There was a very inflamed and large exiting nerve
root.  I tried to retract as I was unable to do so.  I attempted this
on the right as well as the left side, it was determined that a large
interbody most likely a 13-14 mm with cause injury to the nerve root.
 Instead, I made an annulotomy window.  I removed the disks and the
endplate was prepared ends and inserted bone graft including
autograft as well as by allograft into this space.  Hemostasis was
maintained.  I then concentrated pedicle screw insertion, screws
inserted over the previous wires from L4 through S1, total of 6
screws were placed.  The rod was inserted.  The cap was inserted.
Final tightening was done.  Posterolateral elements were decorticated
and prepared for arthrodesis grafting.  Bone graft was placed along
the gutters from L4 through S1 bilaterally.

Would this be coded to 22612 instead of 22633 since no device was placed and it's not specified that a structural graft was used?


  • It seems to me that 22633 is supported, he does document the autograft and allograft inserted in the disc space. I would definitely get clarification on whether or not any structural allograft was used. Double check the implant list on the op note, he may have documented it there. 
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