How To Use CPT Code 22558

CPT 22558 refers to an anterior interbody arthrodesis procedure performed on the lumbar spine to alleviate persistent pain caused by a herniated disk or other spinal condition. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 22558 procedures.

1. What is CPT 22558?

CPT 22558 is a medical code used to describe an anterior interbody arthrodesis procedure performed on the lumbar spine. This surgical procedure involves the permanent joining of two vertebrae to alleviate persistent pain caused by a herniated disk or other spinal condition. The surgeon accesses the spine through an incision in the abdomen and removes disk material to create space for the fusion.

2. 22558 CPT code description

The official description of CPT code 22558 is: “Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar.”

3. Procedure

The 22558 procedure involves the following steps:

  1. The patient is appropriately prepped and anesthetized.
  2. The provider makes an incision on the left side of the abdomen.
  3. Abdominal muscles are retracted to one side, and the intact peritoneum is retracted to reach the lumbar spine.
  4. The target vertebrae are identified.
  5. The annulus is removed, and a curette is used to remove some of the disk material to create space inside.
  6. The bony end plate is drilled, and bone graft is inserted into the empty disk space.
  7. The area is irrigated, checked for bleeding, and any instruments are removed.
  8. The incision is closed.

4. Qualifying circumstances

Patients eligible to receive CPT code 22558 services are those experiencing persistent pain caused by a herniated disk or other spinal condition that has not responded to conservative treatments such as physical therapy, medication, or injections. The patient’s medical history, imaging studies, and physical examination findings should support the need for an anterior interbody arthrodesis procedure.

5. When to use CPT code 22558

It is appropriate to bill the 22558 CPT code when a provider performs an anterior interbody arthrodesis procedure on the lumbar spine to alleviate persistent pain caused by a herniated disk or other spinal condition. The patient’s medical history, imaging studies, and physical examination findings should support the need for this procedure, and conservative treatments should have been tried without success.

6. Documentation requirements

To support a claim for CPT 22558, the following information should be documented:

  • Patient’s medical history, including conservative treatments tried without success
  • Physical examination findings
  • Imaging studies supporting the need for the procedure
  • Operative report detailing the steps of the procedure
  • Postoperative care and follow-up

7. Billing guidelines

When billing for CPT code 22558, it is essential to follow the appropriate guidelines and rules. Ensure that the patient’s medical history, imaging studies, and physical examination findings support the need for the procedure. Additionally, document the operative report in detail, including the steps of the procedure and postoperative care. Note that arthrodesis codes do not include the harvest of spinal bone grafts or spinal instrumentation, so these should be reported separately if applicable.

8. Historical information

CPT 22558 was added to the Current Procedural Terminology system on January 1, 1990. There have been several updates to the code since its addition, including a change in the descriptor on January 1, 2007, and various changes to its Medicare status in 2017, 2021, and 2022.

9. Similar codes to CPT 22558

Five similar codes to CPT 22558 and how they differentiate are:

  • CPT 22554: This code is for an anterior interbody arthrodesis procedure performed on the cervical spine instead of the lumbar spine.
  • CPT 22556: This code describes a posterior interbody arthrodesis procedure on the lumbar spine, which involves a different surgical approach than CPT 22558.
  • CPT 22585: This code is used for each additional interspace in an anterior interbody arthrodesis procedure, in addition to the primary code (such as CPT 22558).
  • CPT 22586: This code refers to an arthrodesis procedure using a pre-sacral interbody technique, which is a different technique than the one described in CPT 22558.
  • CPT 22612: This code is for a posterior or posterolateral arthrodesis procedure on the lumbar spine, which involves a different surgical approach and technique than CPT 22558.

10. Examples

Here are 10 detailed examples of CPT code 22558 procedures:

  1. A 45-year-old patient with a history of chronic low back pain due to a herniated L4-L5 disk undergoes an anterior interbody arthrodesis procedure after conservative treatments have failed.
  2. A 55-year-old patient with degenerative disk disease at the L3-L4 level undergoes an anterior interbody arthrodesis procedure to alleviate persistent pain and instability.
  3. A 60-year-old patient with spondylolisthesis at the L5-S1 level undergoes an anterior interbody arthrodesis procedure to stabilize the spine and relieve pain.
  4. A 50-year-old patient with a history of lumbar spinal stenosis and a herniated L2-L3 disk undergoes an anterior interbody arthrodesis procedure after conservative treatments have failed.
  5. A 65-year-old patient with degenerative scoliosis and a herniated L4-L5 disk undergoes an anterior interbody arthrodesis procedure to correct spinal alignment and alleviate pain.
  6. A 40-year-old patient with a history of chronic low back pain due to a herniated L3-L4 disk undergoes an anterior interbody arthrodesis procedure after conservative treatments have failed.
  7. A 70-year-old patient with degenerative disk disease at the L5-S1 level undergoes an anterior interbody arthrodesis procedure to alleviate persistent pain and instability.
  8. A 35-year-old patient with spondylolisthesis at the L4-L5 level undergoes an anterior interbody arthrodesis procedure to stabilize the spine and relieve pain.
  9. A 62-year-old patient with a history of lumbar spinal stenosis and a herniated L1-L2 disk undergoes an anterior interbody arthrodesis procedure after conservative treatments have failed.
  10. A 58-year-old patient with degenerative scoliosis and a herniated L3-L4 disk undergoes an anterior interbody arthrodesis procedure to correct spinal alignment and alleviate pain.

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