Spinal Arthrodesis Techniques
In the past couple of years there have been numerous changes made to the code sets for reporting arthrodesis techniques, instrumentation and bone grafts versus biomechanical devices so let’s review some of those changes.
Combination codes - New codes established to report procedures that are commonly performed together
22551 – Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2
This CPT code combines services that used to be reported separately like the anterior interbody technique and also a decompression (discectomy) of the nerve roots. An anterior cervical discectomy (63075) can no longer be reported with the new code 22551 because “discectomy, osteophytectomy and decompression” are already included as part of the code descriptor for 22551.
22633 –Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient enough to prepare interspace (other than for decompression), single interspace and segment; lumbar
Here we have the combined techniques of posterior arthrodesis and posterior interbody arthrodesis. This is accomplished by inserting a spinal cage or structural bone graft into the vertebral interspace (the area between the two vertebral bodies where the disc is located) and then decorticating an area such as the facet joints and placing bone grafting material. We used to report separate codes for each technique but now these two services have been combined and when performed together only one code, 22633 can be reported. Note however the difference between 22551 and 22633. CPT code 22633 does not include the decompression, so in cases where the patient had a ruptured disc and a hemilaminectomy with discectomy is performed, code 63030 may be additionally reported.
Take a patient that had an anterior cervical fusion at C5-C6 and now presents with a herniated disc at C6-C7. The old anterior instrumentation is removed at C5-C6 then a discectomy is performed at C6-C7 with the insertion of a synthetic cage and then the anterior cervical plate is replaced spanning the C5-C7 vertebral bodies. According to the revised coding guidelines in the CPT manual the coder should not report reinsertion of a spinal fixation device but rather the insertion for new instrumentation to include all or part of the previously instrumented levels. For this example add-on code 22845 for three vertebral segments (C5, C6 and C7) would be the correct code.
Bone Grafts vs. Biomechanical Devices
With interbody techniques some type of device is inserted into the intervertebral space. It’s important for the coder to be able to differentiate between these devices. Any type of structural bone graft, whether it is an allograft or autograft should be coded with 20931 (allograft) or 20938 (autograft). There is no such thing as a bone biomechanical device, if it is made from bone it is considered a bone graft. Biomechanical devices are devices made from synthetic materials such as metal or plastics and are reported with CPT code 22851.