Chapter 3 / Spine, spinal cord and peripheral nerves

There are a large number of codes covering most clinical situations for spinal surgery. The various codes for spinal decompression, removal of disc fusion and instrumentation should be used singly and not combined except in very unusual circumstances.

Spinal fusion includes bone grafting and this should not be charged separately.

Spinal decompression includes removal of disc matter and rhizolysis. These should not be charged separately.

Spinal surgery is frequently multi-level. Multiple level surgery does not constitute a multiple procedure and will not be reimbursed as such except in the cervical region.

Chemonucleolysis includes discography and this should not be charged separately.

Codes V4100, V4120 and V4000 are for treatment where the primary pathology is idiopathic adolescent scoliosis. They are not for any other purpose and specifically not for correction of degenerative scoliosis.

The code for Posterior Lumbar Interbody Fusion is V3362 and the narrative has been amended to reflect this.


3.1 - Spinal column (including intervertebral discs)

Code Description Complexity Procedure fees Anaesthetist fees
Unacceptable Combinations



Cervical region

V2200 Posterior decompression +/- foraminotomy - cervical region (1 or 2 levels) Complex £1,200.00 £440.00 Show arrow
V2282 Prosthetic intervertebral disc replacement - cervical region (1 or 2 levels) Complex £1,300.00 £825.00 Show arrow
V2300 Revisional posterior decompression +/– foraminotomy (cervical region) Complex £1,300.00 £440.00 Show arrow
V2990 Open door laminoplasty of the cervical region (Hirobyashi) Complex £1,200.00 £440.00 Show arrow
V3720 Posterior fusion +/- instrumentation - cervical region (1 or 2 levels) Xmajor £1,000.00 £440.00 Show arrow
V2900 Anterior discectomy - cervical region (1 or 2 levels) Xmajor £1,000.00 £440.00 Show arrow
V2902 Revisional anterior discectomy (cervical region) Complex £1,300.00 £495.00 Show arrow
V2950 Anterior discectomy, decompression and fusion (including bone grafting) - cervical region (1 or 2 levels) Complex £1,200.00 £495.00 Show arrow
V2980 Combined anterior and posterior fusion of cervical spine Complex £1,600.00 £550.00 Show arrow
V3730 Trans oral surgery including posterior fixation Complex £1,600.00 £495.00 Show arrow
V3721 Posterior fusion +/- instrumentation - cervical region (3 or more levels) Xmajor £1,000.00 £440.00 Show arrow
V2901 Anterior discectomy - cervical region (3 or more levels) Xmajor £1,000.00 £440.00 Show arrow
V2201 Posterior decompression +/- foraminotomy - cervical region (3 or more levels) Complex £1,200.00 £440.00 Show arrow
V2283 Prosthetic intervertebral disc replacement - cervical region (3 or more levels) Complex £1,300.00 £825.00 Show arrow
V2951 Anterior discectomy, decompression and fusion (including bone grafting) - cervical region (3 or more levels) Complex £1,200.00 £495.00 Show arrow
Thoracic region

V2402 Posterior decompression (thoracic region) Xmajor £1,200.00 £440.00 Show arrow
V2400 Posterior decompression with fusion (thoracic region) Complex £1,200.00 £440.00 Show arrow
V2430 Revisional posterior decompression with fusion (thoracic region) Complex £1,300.00 £440.00 Show arrow
V3120 Transthoracic/antero-lateral excision of intervertebral disc +/– fusion Complex £1,300.00 £440.00 Show arrow
V3122 Revisional transthoracic/antero-lateral excision of intervertebral disc +/– fusion Complex £1,600.00 £1,100.00 Show arrow
V3140 VATS percutaneous discectomy +/– fusion (thoracic region) Xmajor £600.00 £275.00 Show arrow
V3100 Combined anterior discectomy and posterior fusion (thoracic region) Complex £1,300.00 £440.00 Show arrow
V3102 Revisional combined anterior discectomy and posterior fusion (thoracic region) Complex £1,600.00 £1,100.00 Show arrow
V3181 Prosthetic intervertebral disc replacement in the thoracic spine Complex £1,300.00 £825.00 Show arrow
Lumbar region

V2540 Posterior excision of disc prolapse (including microdiscectomy +/- decompression) - lumbar region (1 or 2 levels) Xmajor £900.00 £275.00 Show arrow
V2544 Revision of posterior excision of disc prolapse (lumbar region) Complex £1,000.00 £385.00 Show arrow
V2542 Posterior excision of disc prolapse with undercutting facetectomy +/- decompression - lumbar region (1 or 2 levels) Xmajor £900.00 £330.00 Show arrow
V2543 Revision of posterior excision of disc prolapse with undercutting facetectomy (lumbar region) Complex £1,200.00 £385.00 Show arrow
V2560 Decompression for central spinal stenosis (one or two levels) Xmajor £900.00 £385.00 Show arrow
V2562 Decompression for central spinal stenosis (three or more levels) Complex £1,000.00 £440.00 Show arrow
A5410 Epidural blood patch Minor £150.00 £0.00 Show arrow
A5290 Transforaminal epidural Intermediate £200.00 £110.00 Show arrow
V3345 Mobilisation of the lumbar/thoracic vessels to provide spinal surgical access (by vascular surgeon) as sole procedure Major £650.00 £0.00 Show arrow
V3381 Prosthetic intervertebral disc replacement - lumbar region (3 or more levels) Complex £1,300.00 £990.00 Show arrow
V3341 Primary anterior discectomy, decompression and anterior fusion +/- instrumentation - lumbar region (3 or more levels) Xmajor £1,000.00 £495.00 Show arrow
V2501 Primary posterior fusion +/- decompression +/- discectomy - lumbar region (3 or more levels) Complex £1,000.00 £385.00 Show arrow
V2546 Posterior excision of disc prolapse with undercutting facetectomy +/- decompression - lumbar region (3 or more levels) Xmajor £900.00 £330.00 Show arrow
V2541 Posterior excision of disc prolapse (including microdiscectomy +/- decompression) - lumbar region (3 or more levels) Xmajor £900.00 £275.00 Show arrow
V2570 Percutaneous vertebroplasty Xmajor £1,000.00 £385.00 Show arrow
V2660 Revision of decompression for central spinal stenosis Complex £1,000.00 £440.00 Show arrow
V2500 Primary posterior fusion +/- decompression +/- discectomy - lumbar region (1 or 2 levels) Complex £1,000.00 £385.00 Show arrow
V3362 Primary posterior fusion with instrumentation +/- decompression +/- discectomy (including Graf stabilisation and all fusion approaches) (lumbar region) Complex £1,500.00 £495.00 Show arrow
V2652 Revision posterior fusion +/– instrumentation (lumbar region) Complex £1,500.00 £385.00 Show arrow
V3340 Primary anterior discectomy, decompression and anterior fusion +/- instrumentation - lumbar region (1 or 2 levels) Xmajor £1,000.00 £495.00 Show arrow
V3350 Combined anterior approach discectomy, decompression and fusion and posterior fusion (lumbar region) Complex £1,600.00 £550.00 Show arrow
V3380 Prosthetic intervertebral disc replacement - lumbar region (1 or 2 levels) Complex £1,300.00 £990.00 Show arrow
V4140 Removal of posterior spinal implant Major £450.00 £220.00 Show arrow
V4740 Image guided percutaneous spinal biopsy Major £550.00 £220.00 Show arrow
V4900 Open biopsy of lesion of spine where no other operative procedure on the spine is performed. Major £500.00 £220.00 Show arrow
V5210 Chemonucleosis (multiple levels) Intermediate £550.00 £165.00 Show arrow
W0660 Coccygectomy (multiple levels) Intermediate £400.00 £165.00 Show arrow
V5230 Discogram/diagnostic vertebral disc injection under X-ray control Minor £100.00 £0.00 Show arrow
V5002 Manipulation of spine under GA/IV sedation (sole procedure) Minor £100.00 £100.00 Show arrow
V5003 Manipulation of spine without GA/IV sedation (as sole procedure) Minor £50.00 £0.00 Show arrow
V2680 Revision anterior decompression with fusion and instrumentation (lumbar region) Complex £1,300.00 £495.00 Show arrow
Scoliosis (including kyphosis, fractures, tumours and infections)

V4100 Posterior correction of idiopathic juvenile scoliosis with instrumentation, +/- fusion (including spinal cord monitoring) Complex £2,500.00 £1,000.00 Show arrow
V4120 Anterior correction of idiopathic juvenile scoliosis with instrumentation, +/- fusion (including spinal cord monitoring) Complex £2,500.00 £1,000.00 Show arrow
V4000 Combined anterior and posterior correction and instrumentation, +/- fusion of idiopathic juvenile scoliosis (including spinal monitoring) Complex £2,500.00 £1,100.00 Show arrow
V4280 Correction of adult degenerative or adult scoliosis including decompression +/- fusion (including spinal cord monitoring) Complex £2,000.00 £900.00 Show arrow
V4010 Posterior correction of idiopathic juvenile kyphosis with instrumentation, +/- fusion (including spinal cord monitoring) Complex £2,500.00 £1,000.00 Show arrow
V4122 Anterior correction of idiopathic juvenile kyphosis with instrumentation, +/- fusion (including spinal cord monitoring) Complex £2,500.00 £1,000.00 Show arrow
V4160 Posterior correction of degenerative adult kyphosis with instrumentation, +/- fusion (including spinal cord monitoring) Complex £1,600.00 £550.00 Show arrow
V4150 Anterior correction of degenerative adult kyphosis with instrumentation, +/- fusion (including spinal cord monitoring) Complex £1,600.00 £550.00 Show arrow
V4300 Anterior vertebrectomy with decompression and implant Complex £2,500.00 £1,000.00 Show arrow
V4302 Combined anterior vertebrectomy with posterior fusion and instrumentation Complex £2,500.00 £1,100.00 Show arrow
V4142 Removal of posterior scoliosis instrumentation (as sole procedure) Major £450.00 £220.00 Show arrow
W2912 Application of halo (as sole procedure) Intermediate £200.00 £165.00 Show arrow
V4451 Balloon kyphoplasty – single level Major £600.00 £220.00 Show arrow
V4452 Balloon kyphoplasty - two level Xmajor £750.00 £275.00 Show arrow
V4453 Balloon kyphoplasty - greater than two levels Xmajor £900.00 £275.00 Show arrow

3.2 - Spinal cord

Code Description Complexity Procedure fees Anaesthetist fees
Unacceptable Combinations



A4400 Partial excision of spinal cord Complex £1,300.00 £495.00
A4500 Open operations on spinal cord Complex £1,300.00 £495.00 Show arrow
A4730 Percutaneous cordotomy of spinal cord Xmajor £750.00 £275.00 Show arrow
A4850 Implantation/removal of intrathecal drug delivery system Major £500.00 £220.00
A4860 Implantation/removal of epidural delivery system Major £500.00 £220.00
A4900 Repair of spinal myelomeningocele Complex £1,000.00 £440.00
A5110 Excision of intradural lesion Complex £1,300.00 £495.00
A5300 Drainage of spinal canal (including insertion of shunt) Xmajor £750.00 £275.00
A5530 Lumbar puncture (including spinal manometry) Minor £100.00 £100.00 Show arrow
A5580 CSF infusion studies Intermediate £250.00 £110.00 Show arrow
V4980 Excision of intramedullary tumour Complex £1,300.00 £495.00
A4831 Trial of neurostimulator to spinal cord (as sole procedure) not at time of permanent implant Major £800.00 £330.00 Show arrow
A4832 Implantation of spinal cord stimulator Major £1,300.00 £330.00 Show arrow

3.3 - Paraspinal injections

Code Description Complexity Procedure fees Anaesthetist fees
Unacceptable Combinations



25010 Paravertebral block up to two levels (without X-ray control) £120.00 £0.00 Show arrow
25011 Paravertebral block up to two levels (under X-ray control) Minor £200.00 £110.00 Show arrow
25012 Sacral root block (under X-ray control) Minor £200.00 £110.00
25020 Intravenous regional sympathetic block (guanethidine block) - 1 injection Minor £150.00 £0.00
25030 Stellate ganglion block (neurolytic) Minor £200.00 £110.00 Show arrow
25100 Coeliac plexus block, splanchnic nerve block, hypogastric block - diagnostic Intermediate £350.00 £110.00 Show arrow
25110 Coeliac plexus block, splanchnic nerve block, hypogastric block - therapeutic Intermediate £350.00 £110.00 Show arrow
25120 Dorsal root ganglion block (local anaesthetic or neurolytic) (as sole procedure) Intermediate £300.00 £110.00 Show arrow
25130 Dorsal root ganglion block (radiofrequency) Major £450.00 £110.00
25140 Intrathecal neurolysis Intermediate £350.00 £110.00
25150 Trigeminal ganglion injection (local anaesthetic under X-ray control) Intermediate £350.00 £0.00 Show arrow
25160 Trigeminal ganglion radiofrequency lesion (under X-ray control) Intermediate £600.00 £220.00 Show arrow
A5200 Epidural injection (cervical) Intermediate £150.00 £0.00 Show arrow
A5210 Epidural injection (lumbar) Minor £150.00 £0.00 Show arrow
A5220 Epidural injection (thoracic) Intermediate £150.00 £0.00 Show arrow
A5230 Epidurogram Minor £150.00 £150.00 Show arrow
A5420 Injection of therapeutic substance into CSF Minor £100.00 £0.00 Show arrow
A5720 Facet or sacroiliac joint (RF) radiofrequency thermocoagulation, cryotherapy or phenol (including rhizolysis under image guidance) - up to 3 joints Intermediate £400.00 £165.00 Show arrow
A5730 Facet or sacroiliac joint (RF) radiofrequency thermocoagulation, cryotherapy or phenol (including rhizolysis under image guidance) - 4 to 6 joints Major £550.00 £220.00 Show arrow
A5752 Medial Branch Block (under x-ray control) - 1 to 2 levels Intermediate £200.00 £0.00 Show arrow
A5762 Medial Branch Block (under x-ray control) - 3 to 4 levels Intermediate £250.00 £0.00 Show arrow
A5772 Medial Branch Block (under x-ray control) - 5 to 6 levels Intermediate £300.00 £0.00 Show arrow
A5790 Sacroiliac joint injection under image guidance (and bilateral) Minor £150.00 £0.00 Show arrow
A5211 Epidural injection (caudal) Minor £150.00 £0.00 Show arrow
A5751 Facet joint injection (under x-ray control) - 1 to 2 joints Intermediate £200.00 £0.00 Show arrow
A5761 Facet joint injection (under x-ray control) - 3 to 4 joints Intermediate £250.00 £0.00 Show arrow
A5771 Facet joint injection (under x-ray control) - 5 or more joints Intermediate £300.00 £0.00 Show arrow
AA460 Destruction of branch of trigeminal nerve (neurolytic/RF/cryoprobe) Intermediate £600.00 £220.00

3.4 - Nerve roots

Code Description Complexity Procedure fees Anaesthetist fees
Unacceptable Combinations



A5780 Rhizolysis Xmajor £750.00 £275.00 Show arrow

3.5 - Sympathetic nerves

Code Description Complexity Procedure fees Anaesthetist fees
Unacceptable Combinations



25020 Intravenous regional sympathetic block (guanethidine block) - 1 injection Minor £150.00 £0.00
25022 Stellate ganglion block (local anaesthetic) Minor £150.00 £110.00 Show arrow
25030 Stellate ganglion block (neurolytic) Minor £200.00 £110.00 Show arrow
25100 Coeliac plexus block, splanchnic nerve block, hypogastric block - diagnostic Intermediate £350.00 £110.00 Show arrow
25110 Coeliac plexus block, splanchnic nerve block, hypogastric block - therapeutic Intermediate £350.00 £110.00 Show arrow
A7500 Lumbar sympathectomy diagnostic (local anaesthetic under X-ray control) Intermediate £300.00 £110.00 Show arrow
A7510 Thorascopic cervical sympathectomy Xmajor £700.00 £275.00
A7520 Thoracic sympathectomy diagnostic (local anaesthetic under X-ray control) Intermediate £300.00 £110.00 Show arrow
A7530 Laparoscopic lumbar sympathectomy Major £550.00 £275.00 Show arrow
A7600 Lumbar sympathectomy therapeutic (neurolytic under X-ray control) Intermediate £400.00 £165.00 Show arrow
A7620 Thoracic sympathectomy therapeutic (neurolytic under X-ray control) Major £450.00 £165.00 Show arrow
A7682 Presacral sympathectomy - diagnostic Major £450.00 £220.00 Show arrow
A7683 Presacral sympathectomy - therapeutic Major £450.00 £220.00 Show arrow
A7085 Sacral nerve stimulation for faecal/urinary incontinence or constipation Major £700.00 £330.00 Show arrow

3.6 - Peripheral nerves

Code Description Complexity Procedure fees Anaesthetist fees
Unacceptable Combinations



A6030 Transection of peripheral nerve for neuroma Intermediate £250.00 £165.00 Show arrow
A6080 Neurectomy (major nerve) Intermediate £400.00 £165.00 Show arrow
A6110 Excision of lesion of peripheral nerve (eg neurilemoma) Intermediate £300.00 £165.00 Show arrow
A6180 Excision of lesion of major nerve Intermediate £400.00 £165.00 Show arrow
A6300 Graft to peripheral nerve Xmajor £650.00 £275.00 Show arrow
A6302 Graft to major nerve Xmajor £650.00 £275.00 Show arrow
A6400 Repair of peripheral nerve Intermediate £250.00 £165.00 Show arrow
A6402 Repair of major nerve Major £300.00 £165.00 Show arrow
A6510 Carpal tunnel release (open) Intermediate £250.00 £165.00 Show arrow
A6580 Carpal tunnel release (open) - bilateral Intermediate £450.00 £275.00 Show arrow
A6600 Release of entrapment of deeply placed peripheral nerve Intermediate £250.00 £165.00 Show arrow
A6700 Release of entrapment of peripheral nerve Intermediate £250.00 £165.00 Show arrow
A6710 Cubital tunnel release (open) (without transposition) Intermediate £250.00 £165.00 Show arrow
A6711 Cubital tunnel release (open) bilateral (without transposition) Intermediate £450.00 £275.00 Show arrow
A6810 Neurolysis and transposition of peripheral nerve (excludes carpal tunnel release) Intermediate £300.00 £165.00 Show arrow
A6900 Revision of release of peripheral nerve Major £450.00 £165.00 Show arrow
A7010 Implantation of neurostimulator into peripheral nerve Major £550.00 £110.00 Show arrow
A7011 Trial of neurostimulator to peripheral nerve (as sole procedure) not at time of permanent implant Intermediate £450.00 £110.00 Show arrow
A7013 Placement of tined lead neurostimulator not at time of permanent implant Intermediate £450.00 £110.00 Show arrow
A6530 Carpal tunnel release (endoscopic) Intermediate £250.00 £165.00 Show arrow
A6570 Carpal tunnel release (endoscopic) - Bilateral Intermediate £450.00 £275.00 Show arrow
A6740 Cubital tunnel release (endoscopic) (without transposition) Intermediate £250.00 £165.00 Show arrow
A6750 Cubital tunnel release (endoscopic) Bilateral (without transposition) Intermediate £450.00 £275.00 Show arrow
A7310 Biopsy of peripheral nerve Intermediate £250.00 £165.00
A7340 Exploration and grafting of brachial plexus Complex £1,000.00 £660.00 Show arrow

3.7 - Other nerve blocks

Code Description Complexity Procedure fees Anaesthetist fees
Unacceptable Combinations



25150 Trigeminal ganglion injection (local anaesthetic under X-ray control) Intermediate £350.00 £0.00 Show arrow
A7300 Radiofrequency (including pulsed denervation), cryoprobe or phenol for permanent lesion of major nerve trunk Intermediate £200.00 £220.00 Show arrow
A7302 Continuous nerve block as sole procedure Minor £100.00 £0.00 Show arrow
A7352 Image-guided local anaesthetic blockade of named major nerve or plexus Minor £150.00 £0.00 Show arrow
AA460 Destruction of branch of trigeminal nerve (neurolytic/RF/cryoprobe) Intermediate £600.00 £220.00

3.8 - Other procedures

Code Description Complexity Procedure fees Anaesthetist fees
Unacceptable Combinations



V6080 Percutaneous disc decmpression using coblation Major £650.00 £250.00
25160 Trigeminal ganglion radiofrequency lesion (under X-ray control) Intermediate £600.00 £220.00 Show arrow
T6520 Tendon sheath injection Minor £100.00 £0.00 Show arrow
T7290 Trigger point injection/Enthesis - one injection Minor £100.00 £0.00 Show arrow
T7292 Trigger point injection/Enthesis - more than one injection Minor £100.00 £0.00 Show arrow
V5484 Interspinous dynamic stabilisation procedure Xmajor £700.00 £275.00 Show arrow
X3750 Botulinum toxin injections to muscle Minor £100.00 £0.00 Show arrow
X3770 Intramuscular injection with X-ray control (eg piriformis block) Minor £150.00 £0.00 Show arrow
Y3800 Insertion of indwelling axillary catheter Intermediate £200.00 £0.00 Show arrow
Y3810 Insertion of indwelling pleural catheter Intermediate £200.00 £0.00 Show arrow
Y3820 Insertion of indwelling psoas catheter Intermediate £200.00 £0.00 Show arrow

3.9 - Neurophysiological procedures

Code Description Complexity Procedure fees Anaesthetist fees
Unacceptable Combinations



22000 Routine electroencephalography (EEG) in adult or child aged over 5 (Including reporting) £75.00 £0.00 Show arrow
22002 Routine electroencephalography (EEG) in child under 5 (including reporting) Minor £100.00 £0.00 Show arrow
22003 Sleep Electroencephalography (EEG) Minor £100.00 £0.00 Show arrow
22004 24 hour ambulatory Electroencephalography (EEG) (Including reporting) Minor £100.00 £0.00 Show arrow
22005 24 hour video telemetry Electroencephalography (EEG) (Including reporting) Minor £100.00 £0.00 Show arrow
22011 Recording and reporting on evoked potential study Minor £200.00 £0.00
22022 Recording and reporting on electromyography and nerve conduction studies (EMG); CTS (Bilateral upper limb only) or peripheral neuropathy Minor £150.00 £0.00 Show arrow
22023 Recording and reporting on electromyography and nerve conduction studies (EMG); Mononeuropathy (eg ulnar), Cx/Lumbar radiculopathy, Myopathy Minor £200.00 £0.00 Show arrow
22024 Recording and reporting on electromyography and nerve conduction studies (EMG); Mononeuritis Multiplex, MND-AHC, Multiple Muscle Monitoring (eg Torticollis), Myaesthenia Gravis (- SFEMG) Minor £200.00 £0.00 Show arrow
22025 Recording and reporting on electromyography and nerve conduction studies (EMG); Myaesthenia Gravis (+ SFEMG) Minor £200.00 £0.00 Show arrow
22028 Sleep study (polysomnography) including reporting Minor £100.00 £0.00 Show arrow



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