How To Use CPT Code 0098T

CPT 0098T refers to the revision and replacement of a total disc arthroplasty (artificial disc) through an anterior approach, specifically for each additional interspace in the cervical spine. This procedure is typically performed when an existing artificial disc has either shifted from its original position or has sustained damage, necessitating its replacement during the same surgical session as the initial cervical artificial disc procedure. The goal of this intervention is to alleviate symptoms associated with degenerative disc disease or trauma by ensuring proper alignment and function of the cervical spine.

1. What is CPT code 0098T?

CPT code 0098T is designated for the surgical procedure involving the revision and replacement of an artificial disc in the cervical spine, specifically when addressing additional interspaces beyond the primary procedure. This code is utilized in the context of total disc arthroplasty, which is a surgical technique that replaces a damaged or degenerated intervertebral disc with an artificial implant. The cervical spine, comprising the first seven vertebrae (C1-C7), is particularly susceptible to conditions such as degenerative disc disease, which can lead to pain, reduced mobility, and neurological symptoms. The use of an artificial disc aims to restore normal disc function, maintain spinal alignment, and provide pain relief.

2. Qualifying Circumstances

This CPT code can be used when a patient requires the revision and replacement of an artificial disc in an additional cervical interspace during the same operative session as the primary procedure. It is important to note that this code is an add-on code, meaning it should be reported in conjunction with the primary procedure code (22861). The use of 0098T is appropriate in scenarios where the initial artificial disc has become dislodged or damaged, and the surgeon determines that further intervention is necessary to ensure the stability and functionality of the cervical spine. However, it is inappropriate to use this code if no additional interspace is being addressed or if the primary procedure does not involve cervical disc arthroplasty.

3. When To Use CPT 0098T

CPT code 0098T should be used when a surgeon performs a revision and replacement of an artificial disc in an additional cervical interspace during the same surgical session as the primary procedure. It is crucial to report this code only once for each additional interspace being addressed. The code should be used alongside the primary code 22861, which pertains to the initial cervical artificial disc procedure. It is important to avoid using 0098T in conjunction with codes that do not relate to cervical disc procedures, as this could lead to billing inaccuracies.

4. Official Description of CPT 0098T

Official Descriptor: Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, cervical (List separately in addition to code for primary procedure).

5. Clinical Application

The clinical application of CPT code 0098T is centered around the need for surgical intervention in cases where an artificial disc in the cervical spine requires revision or replacement. This procedure is critical for patients suffering from complications related to their initial disc replacement, such as pain, instability, or neurological deficits. The successful execution of this procedure can significantly improve a patient’s quality of life by restoring proper spinal function and alleviating discomfort associated with disc degeneration or displacement.

5.1 Provider Responsibilities

During the procedure associated with CPT code 0098T, the provider is responsible for several key actions. Initially, the surgeon must identify the appropriate interspace for the revision by accessing the prevertebral space through an anterior incision in the neck. The provider carefully dissects through any scar tissue from the previous surgery to expose the target area. Once the interspace is accessed, the surgeon may take new measurements to ensure the correct size of the artificial disc prosthesis. The provider then prepares the space for the new implant, which may involve reshaping the area to accommodate the prosthesis. Using fluoroscopy for guidance, the surgeon inserts the new artificial disc, secures it in place, and ensures hemostasis. Finally, the provider meticulously reapproximates the surrounding tissues, places drains if necessary, and closes the incision in layers.

5.2 Unique Challenges

One of the unique challenges associated with the procedure is the presence of scar tissue from previous surgeries, which can complicate access to the surgical site. The surgeon must navigate this tissue carefully to avoid damaging surrounding structures. Additionally, ensuring the correct placement and stability of the new artificial disc is critical, as improper positioning can lead to further complications. The use of fluoroscopy is essential in this regard, as it provides real-time imaging to guide the surgeon during the procedure. Furthermore, the provider must be vigilant in achieving hemostasis to prevent excessive bleeding during and after the surgery.

5.3 Pre-Procedure Preparations

Before performing the procedure associated with CPT code 0098T, the provider must conduct thorough evaluations, including imaging studies such as MRI or CT scans, to assess the condition of the cervical spine and the existing artificial disc. These evaluations help determine the need for revision and the appropriate size and type of the new prosthesis. Additionally, the provider must review the patient’s medical history and any previous surgical interventions to plan the approach and anticipate potential complications.

5.4 Post-Procedure Considerations

After the procedure, the patient requires careful monitoring to assess for any signs of complications, such as infection or improper healing. The provider may need to schedule follow-up appointments to evaluate the success of the revision and ensure that the new artificial disc is functioning correctly. Pain management and rehabilitation may also be necessary to facilitate recovery and restore mobility. The provider should provide the patient with instructions on activity restrictions and signs of complications to watch for during the recovery period.

6. Relevant Terminology

Anterior: Situated in front; in this context, it refers to the approach taken during the surgery, accessing the cervical spine from the front of the neck.

Arthroplasty device: A device used to replace or reconstruct a joint, in this case, an artificial disc replacing a damaged cervical disc.

Cervical vertebrae: The seven vertebrae located in the upper neck of the spinal column, designated as C1 through C7.

Degenerative disc disease: Age-related changes in the spine that lead to deterioration of the intervertebral discs, causing pain and reduced mobility.

Fluoroscopy: A live X-ray technique that allows providers to view body structures in real-time during procedures.

Hemostasis: The process of stopping blood flow, crucial during surgical procedures to prevent excessive bleeding.

Interspace: The space between two vertebral bodies, which contains the intervertebral disc.

Intervertebral disc: A fibrous tissue layer between adjacent vertebrae that acts as a cushion and aids in load-bearing and shock absorption.

Prevertebral: Situated in front of a vertebra or the spinal column.

Prosthesis: An artificial implant that serves as a substitute for a damaged or missing body part.

Reapproximates: To align or rejoin tissue after surgical intervention.

Retractors: Surgical instruments used to hold back tissue or organs during surgery to provide better visibility and access to the surgical site.

Vertebrae: The bony segments that form the spine, categorized into different levels including cervical, thoracic, lumbar, sacral, and coccygeal.

7. Clinical Examples

1. A patient with a previously implanted cervical artificial disc experiences severe pain and instability due to the disc shifting out of place. During a follow-up surgery, the surgeon revises the disc and replaces it with a new prosthesis at an additional interspace.

2. After a traumatic injury, a patient requires revision surgery for a cervical artificial disc that has been damaged. The surgeon performs the procedure, addressing both the primary and an additional interspace during the same session.

3. A patient with degenerative disc disease undergoes an initial cervical artificial disc replacement. However, during the recovery phase, the patient develops complications requiring a second surgery to revise and replace the disc at another interspace.

4. Following a failed initial cervical disc replacement, a patient is scheduled for a revision surgery where the surgeon replaces the artificial disc at an additional interspace, ensuring proper alignment and function.

5. A patient with a history of cervical spine surgeries presents with recurrent symptoms. The surgeon decides to revise the artificial disc at an additional interspace, utilizing CPT code 0098T during the procedure.

6. During a routine follow-up, a patient is found to have a dislodged cervical artificial disc. The surgeon performs a revision and replacement of the disc at the affected interspace and another adjacent interspace in the same operation.

7. A patient with multiple cervical disc replacements experiences complications with one of the discs. The surgeon revises the problematic disc and replaces it while also addressing an additional interspace during the same surgical session.

8. After experiencing persistent neck pain post-surgery, a patient is evaluated and found to require a revision of the cervical artificial disc. The surgeon performs the procedure, replacing the disc at an additional interspace.

9. A patient undergoing a complex cervical spine surgery requires the revision of an artificial disc at an additional interspace due to improper placement during the initial procedure.

10. Following a cervical spine injury, a patient requires a revision of their artificial disc. The surgeon successfully replaces the disc at the original site and addresses an additional interspace, ensuring stability and function.