How To Use CPT Code 22532

CPT code 22532 describes a specific surgical procedure known as arthrodesis, which involves the fusion of two vertebrae in the thoracic spine using a lateral extracavitary approach. This article will provide a comprehensive overview of CPT code 22532, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of when to use this code.

1. What is CPT Code 22532?

CPT code 22532 is used to describe a surgical procedure called arthrodesis, which involves the fusion of two vertebrae in the thoracic spine. This procedure is performed using a lateral extracavitary approach, which allows for a wider view of the surgical site. The purpose of arthrodesis is to permanently join the vertebrae, alleviating persistent pain caused by various spinal conditions such as herniated intervertebral disks, spinal canal narrowing, or spinal injuries.

2. Official Description

The official description of CPT code 22532 is: ‘Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression) thoracic.’

3. Procedure

During the arthrodesis procedure described by CPT code 22532, the healthcare provider performs the following steps:

1. The patient is appropriately prepped and anesthetized.
2. A midline incision is made over the damaged vertebra.
3. The muscles surrounding the spine are elevated.
4. Using imaging guidance, the provider dissects along the ribs and rib cartilage to the costotransverse joint.
5. The associated transverse process, lateral portion of the facet, and pedicle are removed using a drill to expose the lateral aspect of the dural sac and the dorsolateral aspect of the vertebral body.
6. The parietal pleura is depressed and retracted to expose the lateral surface of the vertebral body.
7. The degenerated disk material is removed, and the cartilage is scraped from the vertebral end plates.
8. The outer layer of the bone is decorticated with a high-speed drill.
9. The bone graft is tapped into position between the end plates to achieve fusion while protecting the spinal cord.
10. The area is irrigated, checked for bleeding, and the incision is closed.

4. Qualifying circumstances

CPT code 22532 is used for arthrodesis procedures in the thoracic spine. It is typically performed to address specific spinal conditions that cause persistent pain, such as herniated intervertebral disks, spinal canal narrowing, or spinal injuries. The lateral extracavitary technique is employed to provide a wider view of the surgical site, allowing for better access and visualization during the procedure.

5. When to use CPT code 22532

CPT code 22532 should be used when a healthcare provider performs arthrodesis in the thoracic spine using a lateral extracavitary technique. This code is appropriate when the procedure involves the fusion of two vertebrae and includes a minimal discectomy to prepare the interspace. It is important to note that CPT code 22532 should not be used for decompression procedures.

6. Documentation requirements

When reporting CPT code 22532, the healthcare provider must ensure that the following documentation is included:

• Patient’s diagnosis and the specific spinal condition being addressed
• Description of the lateral extracavitary technique used
• Date of the procedure
• Details of the surgical steps performed, including the minimal discectomy
• Any additional procedures or techniques used in conjunction with arthrodesis
• Any complications or unexpected findings during the procedure
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 22532, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The lateral extracavitary technique must be employed, and the procedure should include a minimal discectomy to prepare the interspace. It is also crucial to follow any additional guidelines provided by payers or regulatory bodies.

8. Historical information

CPT code 22532 was added to the Current Procedural Terminology system on January 1, 2004. Since its addition, there have been several historical changes, including code updates and Medicare changes. Notably, it was added to the Inpatient Only (IPO) list in 2017, removed from the IPO list in 2021, and added back to the IPO list in 2022.

9. Similar codes to CPT 22532

There are several similar codes to CPT code 22532 that describe other arthrodesis procedures on the spine. These include:

• CPT 22533: Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression) lumbar
• CPT 22534: Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression) lumbar and sacral
• CPT 22548: Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression) each additional interspace, lumbar (List separately in addition to code for primary procedure)
• CPT 22558: Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression) each additional interspace, cervical (List separately in addition to code for primary procedure)
• CPT 22585: Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression) each additional interspace, thoracic (List separately in addition to code for primary procedure)

9. Examples

1. A patient with a herniated intervertebral disk in the thoracic spine undergoes arthrodesis using a lateral extracavitary technique (CPT code 22532).