CPT 22612 is a code used for arthrodesis procedures in the lumbar spine, specifically focusing on the posterior or posterolateral technique with a single interspace. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 22612.
1. What is CPT 22612?
CPT 22612 is a medical code used to describe a specific type of spinal fusion surgery, known as arthrodesis, performed on the lumbar spine using a posterior or posterolateral technique. This procedure is intended to permanently join two vertebrae in the lower back to alleviate pain caused by various spinal conditions, such as herniated intervertebral disks, stenosis, and spinal injuries.
2. 22612 CPT code description
The official description of CPT code 22612 is: “Arthrodesis, posterior or posterolateral technique, single interspace; lumbar (with lateral transverse technique, when performed)”.
- The patient is prepped and anesthetized.
- The provider makes a midline incision over the affected lumbar vertebrae in the lower back.
- Subcutaneous tissue and muscles are dissected to visualize the bone.
- Muscles are stripped from the spinous process and posterior lamina out to the mid-portion of the facet joints.
- Decortication is performed with bone cutting instruments.
- Bone graft material is applied to the prepared bony surfaces at the back of the vertebrae, at the back and side, or at the side and across (lateral transverse).
- Metal implants may be inserted to hold the vertebrae together until new bone grows between them (may be separately reportable).
- Muscles and ligaments are sutured over the grafted areas.
- The area is irrigated, checked for bleeding, and instruments are removed.
- The incision is closed, and a brace or immobilization device may be applied.
4. Qualifying circumstances
Patients eligible to receive CPT code 22612 services are those who have been diagnosed with spinal conditions causing persistent pain and have not responded to conservative treatments such as physical therapy, medication, or injections. Conditions that may qualify for this procedure include herniated intervertebral disks, stenosis, and spinal injuries. A thorough evaluation by a healthcare provider is necessary to determine if the patient is a suitable candidate for this procedure.
5. When to use CPT code 22612
CPT code 22612 should be used when billing for an arthrodesis procedure performed on the lumbar spine using a posterior or posterolateral technique with a single interspace. This code is appropriate when the provider has determined that the patient’s condition warrants surgical intervention and the patient meets the qualifying circumstances outlined above.
6. Documentation requirements
Documentation supporting a claim for CPT 22612 should include a detailed medical history, physical examination, imaging studies (such as X-rays, MRI, or CT scans), and a clear diagnosis of the spinal condition requiring the procedure. Additionally, documentation should demonstrate that conservative treatments have been attempted and failed to provide relief. The operative report should include a detailed description of the procedure, including the specific technique used, the level of the spine treated, and any complications or additional procedures performed during the surgery.
7. Billing guidelines
When billing for CPT code 22612, it is essential to follow coding and payer guidelines to ensure proper reimbursement. This code should be reported per interspace, which is the compartment between two vertebrae. Do not report CPT 22612 in conjunction with CPT 22630 for the same interspace; use CPT 22633 instead. Additionally, check coding and payer guidelines to determine whether graft harvesting can be reported separately for the specific case.
8. Historical information
CPT 22612 was added to the Current Procedural Terminology system on January 1, 1990. The code has undergone changes in its descriptor over the years, with the most recent change occurring on January 1, 2022.
9. Similar codes to CPT 22612
- CPT 22630: Similar to CPT 22612 but focuses on the posterior interbody technique.
- CPT 22633: A combination of CPT 22612 and CPT 22630 for the same interspace.
- CPT 22558: Lumbar arthrodesis using an anterior interbody technique.
- CPT 22585: Additional interspace for CPT 22558.
- CPT 22830: Removal of previous lumbar spine fusion without a new fusion.
- A patient with a herniated lumbar disc at L4-L5 undergoes arthrodesis using a posterior technique.
- A patient with lumbar spinal stenosis at L3-L4 undergoes arthrodesis using a posterolateral technique.
- A patient with a spinal injury at L5-S1 undergoes arthrodesis using a posterior technique with lateral transverse.
- A patient with degenerative disc disease at L2-L3 undergoes arthrodesis using a posterolateral technique.
- A patient with spondylolisthesis at L4-L5 undergoes arthrodesis using a posterior technique.
- A patient with lumbar scoliosis at L3-L4 undergoes arthrodesis using a posterolateral technique with lateral transverse.
- A patient with a lumbar vertebral fracture at L1-L2 undergoes arthrodesis using a posterior technique.
- A patient with lumbar instability at L5-S1 undergoes arthrodesis using a posterolateral technique.
- A patient with a lumbar spinal tumor at L2-L3 undergoes arthrodesis using a posterior technique with lateral transverse.
- A patient with lumbar spondylosis at L4-L5 undergoes arthrodesis using a posterolateral technique.