How To Use CPT Code 22842

CPT 22842 refers to posterior segmental instrumentation for 3 to 6 vertebral segments during spinal surgery. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 22842.

1. What is CPT 22842?

CPT 22842 is a medical billing code used to describe the placement of spinal instrumentation at the back of the spine across three to six vertebral segments during a spinal surgery, such as spinal fusion or arthrodesis. This code is an add-on code and must be reported with an appropriate primary procedure.

2. 22842 CPT code description

The official description of CPT code 22842 is: “Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure)”.

3. Procedure

The 22842 procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. While undergoing spinal surgery, the provider identifies the target segments and detaches surrounding tissues and ligaments.
3. The provider drills the posterior cortex, or bony covering, directly posterior to the pedicle.
4. With imaging guidance, the provider enters the pedicle.
5. Screws are placed through the pedicle into the vertebral body on each side of each vertebra to be segmentally fixed.
6. Hooks and clamps may be applied near transverse processes and laminae at the chosen vertebrae.
7. The provider bends the rod or plate to achieve the desired shape for the spine and attaches it to the segmental fixation at each segment with nuts or screws.
8. Alignment is checked on imaging.
9. The provider continues the primary procedure to completion and closes the wound.

4. Qualifying circumstances

Patients eligible to receive CPT code 22842 services are those who require spinal surgery to correct a spinal deformity, such as spinal fusion or arthrodesis. The provider must determine that posterior segmental instrumentation is necessary for the patient’s specific condition and that the instrumentation will involve three to six vertebral segments.

5. When to use CPT code 22842

It is appropriate to bill the 22842 CPT code when the provider places spinal instrumentation at the back of the spine across three to six vertebral segments during a spinal surgery, such as spinal fusion or arthrodesis. This code should be used in conjunction with an appropriate primary procedure code.

6. Documentation requirements

To support a claim for CPT 22842, the following information should be documented:

• The patient’s medical history and diagnosis that necessitates spinal surgery.
• A detailed description of the surgical procedure, including the type of instrumentation used and the number of vertebral segments involved.
• Imaging studies, such as X-rays or MRIs, that support the need for the procedure.
• Operative reports that detail the steps of the procedure and the provider’s findings during surgery.
• Postoperative care instructions and follow-up appointments.

7. Billing guidelines

When billing for CPT code 22842, it is important to follow these guidelines:

• Ensure that the code is used as an add-on code and reported with an appropriate primary procedure.
• Be cautious of potential confusion between vertebral segments and vertebral interspaces, as instrumentation procedures are defined according to vertebral segments, while fusion or arthrodesis procedures are defined according to vertebral interspaces.
• Verify that the provider’s documentation explicitly states the type of instrumentation placed. If the operative report does not specify, ask the provider for clarification.

8. Historical information

CPT 22842 was added to the Current Procedural Terminology system on January 1, 1990. The code was changed on January 1, 2008, with the previous descriptor being “Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments”.

9. Similar codes to CPT 22842

Five similar codes to CPT 22842 and how they differentiate from CPT 22842 are:

1. CPT 22840: This code refers to posterior non-segmental instrumentation, which is different from the segmental instrumentation described in CPT 22842.
2. CPT 22843: This code involves posterior segmental instrumentation for 7 or more vertebral segments, whereas CPT 22842 is for 3 to 6 vertebral segments.
3. CPT 22844: This code describes anterior instrumentation for 2 to 3 vertebral segments, while CPT 22842 refers to posterior instrumentation for 3 to 6 vertebral segments.
4. CPT 22845: This code refers to anterior instrumentation for 4 to 7 vertebral segments, which is different from the posterior instrumentation and the number of segments involved in CPT 22842.
5. CPT 22846: This code involves anterior instrumentation for 8 or more vertebral segments, which is different from the posterior instrumentation and the number of segments involved in CPT 22842.

10. Examples

Here are 10 detailed examples of CPT code 22842 procedures:

1. A patient with scoliosis undergoes a posterior spinal fusion with segmental instrumentation across four vertebral segments.
2. A patient with degenerative disc disease undergoes a lumbar spinal fusion with posterior segmental instrumentation across three vertebral segments.
3. A patient with spinal stenosis undergoes a laminectomy and spinal fusion with posterior segmental instrumentation across five vertebral segments.
4. A patient with spondylolisthesis undergoes a posterior lumbar interbody fusion with segmental instrumentation across six vertebral segments.
5. A patient with a spinal fracture undergoes a posterior spinal fusion with segmental instrumentation across four vertebral segments for stabilization.
6. A patient with kyphosis undergoes a posterior spinal fusion with segmental instrumentation across five vertebral segments to correct the spinal deformity.
7. A patient with a spinal tumor undergoes a spinal decompression and fusion with posterior segmental instrumentation across three vertebral segments for stabilization.
8. A patient with a spinal infection undergoes a debridement and spinal fusion with posterior segmental instrumentation across six vertebral segments for stabilization.
9. A patient with a spinal deformity due to osteoporosis undergoes a posterior spinal fusion with segmental instrumentation across four vertebral segments for stabilization and correction.
10. A patient with a failed previous spinal fusion undergoes a revision surgery with posterior segmental instrumentation across five vertebral segments for stabilization and correction.