How To Use CPT Code 22206

CPT code 22206 describes a surgical procedure known as osteotomy of the spine. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 22206?

CPT 22206 is a code used to describe a specific surgical procedure called osteotomy of the spine. This procedure involves the excision of portions of a thoracic vertebra, which is one of the interlocking bones in the upper back. The purpose of this procedure is to correct kyphosis, an abnormal curvature of the spine. The osteotomy is performed using a posterior or posterolateral approach, and it involves the removal of bone from the back and both sides, or columns, of the vertebra.

2. Official Description

The official description of CPT code 22206 is: ‘Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral body subtraction) thoracic.’

3. Procedure

During the osteotomy procedure, the patient is appropriately prepped and anesthetized. The provider makes an incision in the upper back over the target vertebra and dissects down through the tissues to expose the vertebra. A laminectomy and facetectomy are performed to provide better exposure and decompression of the vertebrae. The provider then resects the pedicle on one side of the vertebra and applies bone wax to seal the bony surfaces. The nerve root is retracted while a wedge of the vertebral body is resected. The same pedicle and wedge resection procedures are repeated on the opposite side of the vertebra. The spine is then repositioned and stabilized to correct the deformity, and intraoperative imaging is used to assess the result. The area is irrigated, a drain is placed, and the incision is closed in layers.

4. Qualifying circumstances

CPT 22206 is used for patients who require an osteotomy of the spine to correct kyphosis. The procedure is performed on the thoracic vertebrae, and it involves the excision of bone from three columns and one vertebral segment. It is important to note that CPT code 22206 should not be reported in conjunction with CPT code 22207.

5. When to use CPT code 22206

CPT code 22206 should be used when a provider performs an osteotomy of the spine using a posterior or posterolateral approach, excising bone from three columns and one vertebral segment in the thoracic region. This code should be used for the initial level of osteotomy. For each additional vertebra, CPT code 22208 should be reported. It is important to note that CPT code 22208 is an add-on code and does not require modifiers.

6. Documentation requirements

To support a claim for CPT code 22206, the provider must document the following information:

• Patient’s diagnosis necessitating the osteotomy
• Specific details of the procedure, including the approach used and the number of columns and vertebral segments involved
• Date of the procedure
• Any additional procedures performed in conjunction with the osteotomy
• Intraoperative imaging findings
• Any complications or unexpected events during the procedure
• Signature of the performing provider

7. Billing guidelines

When billing for CPT code 22206, ensure that the procedure meets the criteria described in the official description. It is important to note that CPT code 22206 should not be reported in conjunction with CPT code 22207. If the provider performs an osteotomy on multiple thoracic vertebrae, report CPT code 22206 for the initial level and CPT code 22208 for each additional vertebra. No modifiers are required for CPT code 22208.

8. Historical information

CPT code 22206 was added to the Current Procedural Terminology system on January 1, 2008. Since its addition, there have been several historical changes, including code updates and changes in Medicare coverage.

9. Similar codes to CPT 22206

There are several similar codes to CPT code 22206 that are used to describe different osteotomy procedures on the spine. These include:

• CPT 22208: Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment, e.g., pedicle and vertebral body subtraction, each additional vertebral segment listed separately in addition to code for primary procedure.
• CPT 22210: Osteotomy of spine, posterior or posterolateral approach, 3 columns, 2 vertebral segments (eg, pedicle/vertebral body subtraction) thoracic.
• CPT 22212: Osteotomy of spine, posterior or posterolateral approach, 3 columns, 3 vertebral segments (eg, pedicle/vertebral body subtraction) thoracic.
• CPT 22214: Osteotomy of spine, posterior or posterolateral approach, 3 columns, 4 vertebral segments (eg, pedicle/vertebral body subtraction) thoracic.
• CPT 22216: Osteotomy of spine, posterior or posterolateral approach, 3 columns, 5 or more vertebral segments (eg, pedicle/vertebral body subtraction) thoracic.

9. Examples

1. A patient with severe kyphosis undergoes a posterior osteotomy of the spine at the T6 vertebra to correct the abnormal curvature.
2. A provider performs a posterolateral osteotomy of the spine at the T8 vertebra to correct kyphosis in a patient with an established diagnosis.
3. An individual with kyphosis undergoes a thoracic osteotomy of the spine using a posterior approach, excising bone from three columns and one vertebral segment.
4. A provider performs an osteotomy of the spine at the T10 vertebra to correct kyphosis in a patient with a documented need for the procedure.
5. A patient with severe kyphosis undergoes a posterior osteotomy of the spine at the T12 vertebra, excising bone from three columns and one vertebral segment.