Osteotomy & Laminectomy Same Level

Question:

I have a question about a complicated surgery and was hoping to get some feedback, as I've been receiving mixed responses and want to ensure these procedures are being reported accurately. Am I able to report any laminectomy that overlaps at the same levels as spinal osteotomies?

Answer:

Great question! Spinal osteotomy is performed to correct spinal deformity and includes laminectomy and decompression at the same level. Because these components are considered inherent to the osteotomy procedure, it is not appropriate to report the laminectomy separately at the same level.

To ensure accurate coding, the operative report should clearly document:

• The type of spinal deformity

• The degree of correction being sought by osteotomy

• Details of how the osteotomy was performed

• The resulting changes from osteotomy

 If the documentation supports spinal osteotomy, it encompasses the laminectomy at that level.

 Thank you for reaching out to KZA with your inquiry.

*This response is based on the best information available as of 03/05/26.

Coding 61750 vs. 61751 for a Stereotactic Biopsy

Question:

We struggle with the code description for CPT 61750 vs 61751. Our providers load MRI and/or CT scans to a stereotactic navigation machine during surgery for Stereotactic biopsy, aspiration, or excision of a tumor. Which code would be correct when an MRI scan is used during surgery? The scan was done prior to going to the OR.

Answer:

Code 61751 is reported regardless of when the CT was performed, and it is typically performed before the patient goes to the OR.

*This response is based on the best information available as of 02/07/26.

Coding Clarification: Instrumentation Removal vs. Exploration Based on Intent

Question:

Good afternoon,

I recently came across one of your Q&As from June 2025 that stated when spinal instrumentation is removed for the purpose of exploration, we would code the exploration CPT code 22830. This is helpful information; however, I am wondering if you can provide a reference for this. I would love to pass this information along to our providers, and a solid source would help to support it.

Answer:

In June 2025, the coding question was clarified:

CPT code 22830 should be billed if the intent for the procedure was for exploration.

If the intent is to explore the spinal fusion site, and instrumentation is removed only to allow that exploration, then CPT 22830 is reported. If the true intent is to remove the instrumentation (e.g., due to pain, infection, or hardware failure), and exploration is incidental, then only the instrumentation removal code is reported.

The National Correct Coding Initiative (NCCI) bundles certain codes based on the principle of standards of medical/surgical practice, which means: If a service is routinely performed as part of another procedure, it is considered integral and not separately reportable.

*This response is based on the best information available as of 01/22/26.

Anterior Approach Spine Fracture

Question:

Good day, my surgeon did a fracture treatment from the anterior approach on the C6-C7 spine; however, he did not do a corpectomy. Should I use the corpectomy code with a 52 modifier or an unlisted code? I was thinking of the comparable code as 22319. Thank you.

Answer:

In spine coding, there are no anterior fracture repair codes outside of the repair of an odontoid fracture. Typically, anterior fracture treatment is reported using existing anterior approach codes, such as anterior cervical discectomy and fusion (ACDF) or corpectomy, depending on the extent of the procedure.

Based on the information provided, it’s unclear precisely what was performed during the surgery, aside from the fact that a corpectomy was not done. Without access to the operative report or more detailed documentation, it’s challenging to make a definitive coding recommendation.

That said, here’s some general guidance: if the vertebral body bone is removed but does not meet the threshold for a corpectomy (which requires removal of at least 50% of the vertebral body for cervical), the procedure would typically be reported as an ACDF. Reviewing the operative note closely or consulting with the surgeon may help clarify whether the procedure aligns more closely with ACDF or warrants the use of an alternative code.

Thank you for reaching out to KZA with your inquiry.

*This response is based on the best information available as of 01/08/26.

Laparoscopic Approach for Shunt

Question:

Can unlisted code 49320 or 49329 be coded along with 62223-62 for a General Surgeon who was a co-surgeon for ventriculo-peritoneal shunt creation if he used a laparoscopy?

Answer:

No, reporting either 49320 or 49329 for the laparoscopic approach is not appropriate.

According to the December 2012 issue of CPT Assistant, code 62230 with modifier 62 may be used by a general surgeon performing the procedure laparoscopically. The provided explanation states that the essential portion of the operation remains the same, and the incision size is not a factor.

Based on this guidance, the correct coding for this scenario is 62223-62 for both the general surgeon and the neurosurgeon.

*This response is based on the best information available as of 12/18/25.

Appropriate CPT Coding for OLLIF

Question:

I have a provider who wants to code 22558 for a procedure that is done posterior only. I am coding as TLIF, posterior interbody fusion with posterolateral fusion and Laminectomy, facetectomy, foraminotomy for decompression with discectomy. He states this is OLLIF not OLIF but still wants 22558. There is no repositioning of the patient. He does not enter the retroperitoneal space. All incisions are done posteriorly. Any guidance?

Answer:

Neither CPT 22558 nor CPT 22633 is appropriate for reporting an OLLIF procedure.

CPT 22558 describes an anterior interbody fusion and requires an anterior or anterolateral approach, typically involving retroperitoneal or transabdominal access. Since OLLIF is performed via a posterior-only, percutaneous approach, it does not meet the criteria for this code.

CPT 22633 describes a posterior interbody fusion combined with posterolateral fusion, typically used for TLIF procedures. However, OLLIF is a distinct technique that does not involve the same surgical exposure or instrumentation as TLIF.

According to CPT Assistant, June 2020, Volume 30, Issue 6, page 14: There is no specific CPT code that accurately describes the OLLIF procedure. Therefore, unlisted code 22899, Unlisted procedure, spine, should be reported. When reporting an unlisted code to describe a procedure or service, it is necessary to submit supporting documentation (e.g., procedure report) with the claim to provide an adequate description of the nature, extent, and need for the procedure, as well as the time, effort, and equipment necessary to provide the service.

Using 22899 ensures accurate representation of the surgical technique and compliance with AMA coding guidance, helping avoid potential denials or audits.

*This response is based on the best information available as of 12/04/25.