How To Use CPT Code 22630

CPT code 22630 describes a specific arthrodesis procedure known as the posterior interbody technique. 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 22630?

CPT 22630 is a code used to describe the posterior interbody technique for arthrodesis procedures in the lumbar spine. This procedure involves the fusion of two vertebrae in the lower back to alleviate persistent pain caused by conditions such as herniated intervertebral disks, stenosis, or spinal injuries.

2. Official Description

The official description of CPT code 22630 is: ‘Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace, lumbar.’

3. Procedure

1. The provider begins by making an incision in the back over the lumbar vertebrae to be fused.
2. Soft tissues are separated and moved aside using retractors to gain access to the vertebrae.
3. The provider then removes fragments from nearby cortical bone and articular cartilage.
4. A laminectomy and/or discectomy may be performed to prepare the interspace for fusion.
5. Bone graft material is inserted between the vertebrae to fill the gap and facilitate fusion.
6. The soft tissues are sutured back into their original positions around the graft site.
7. The area is irrigated, checked for bleeding, and the incision is closed in layers.

4. Qualifying circumstances

CPT 22630 is used for patients who require arthrodesis in the lumbar spine. This procedure is typically performed for conditions such as herniated intervertebral disks, stenosis, or spinal injuries. It is important to note that CPT code 22630 should not be reported in conjunction with CPT code 22612 for the same interspace and segment. Instead, CPT code 22633 should be used.

5. When to use CPT code 22630

CPT code 22630 should be used when the provider performs the posterior interbody technique for arthrodesis procedures in the lumbar spine. This code is specifically for a single interspace and should not be used for decompression procedures. It is important to review coding and payer guidelines to determine if graft harvesting can be reported separately for the specific case.

6. Documentation requirements

To support a claim for CPT code 22630, the provider must document the following information:

• Patient’s diagnosis and the need for arthrodesis in the lumbar spine
• Specific details of the procedure performed, including laminectomy and/or discectomy
• Location of the interspace and segment
• Start and end time of the procedure
• Details of any additional procedures performed
• Any complications or unexpected findings
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 22630, ensure that the procedure performed meets the criteria for the posterior interbody technique for arthrodesis in the lumbar spine. It is important to note that CPT code 22630 should not be reported with CPT code 22612 for the same interspace and segment. Instead, CPT code 22633 should be used. Review coding and payer guidelines to determine if graft harvesting can be reported separately for the specific case.

8. Historical information

CPT code 22630 was added to the Current Procedural Terminology system on January 1, 1990. There have been several historical changes to the code, including being added to the Inpatient Only (IPO) list for Medicare in 2017 and subsequently removed from the IPO list in 2021.

9. Examples

1. A patient with a herniated intervertebral disk undergoes a posterior interbody fusion procedure in the lumbar spine using the posterior interbody technique (CPT code 22630).
2. A provider performs a laminectomy and discectomy to prepare the interspace for fusion in a patient with spinal stenosis. The posterior interbody technique is used for the arthrodesis procedure (CPT code 22630).
3. A patient with a spinal injury requires a fusion procedure in the lumbar spine. The provider performs the posterior interbody technique using bone graft material to facilitate fusion (CPT code 22630).
4. A provider performs a posterior interbody fusion procedure in the lumbar spine for a patient with degenerative disk disease. The arthrodesis is performed using the posterior interbody technique (CPT code 22630).
5. A patient with spondylolisthesis undergoes a fusion procedure in the lumbar spine. The provider utilizes the posterior interbody technique for the arthrodesis (CPT code 22630).