MAY 2015

Instrumentation for Spinal Arthrodesis

There was a time when coding instrumentation for spinal arthrodesis procedures was very basic due to the types of devices being implanted but now there is an ever growing list of new devices and coders need to be familiar with their design and application in order to correctly report instrumentation CPT codes.

When performing an interbody fusion a cage (usually PEEK) will be inserted into the intervertebral space and if an anterior cervical arthrodesis a plate is placed over the vertebral body(s) and if a posterior interbody arthrodesis pedicle screws and/or rods are fixated to the posterior spine. However there are cages that are called modular systems, low profile or stand-alone devices. These types of cages have associated screws that pass directly through the cage and are screwed at an angle into the vertebral endplates rather than using a separate plate and screw system that would be attached to the vertebral body. Another type of cage referred to as an LDR has an upper and lower plate that passes through the cage and into the vertebral endplates to hold the cage in place. When these new generation devices are implanted you would only report 22851 for the biomechanical devices and not 22845 because a separate plate and screws were not used as additional fixation.

When performing posterior instrumentation you need to watch for posterior “interspinous” fixation devices such as Aspen, Inspan or Spire. These plates differ from biomechanical devices in that the plates are attached to both sides of the spinous process at two levels. Because these plates are attached to the spinous process and not placed into the intervertebral space they are not considered biomechanical devices and AMA has recommended reporting Unlisted CPT code 22899 rather than 22851.




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