How To Use CPT Code 22633

CPT 22633 refers to a lumbar arthrodesis procedure that combines posterior or posterolateral techniques with posterior interbody techniques. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT code 22633.

1. What is CPT 22633?

CPT 22633 is a code used to describe a specific type of spinal fusion surgery, known as lumbar arthrodesis. This procedure involves the permanent joining of two adjoining lumbar vertebral bodies using a combination of posterior or posterolateral techniques with posterior interbody techniques. The purpose of this surgery is to prevent further damage or pain in the joint by stabilizing the spine.

2. 22633 CPT code description

The official description of CPT code 22633 is: “Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace, lumbar.”

3. Procedure

1. The patient is appropriately prepped and anesthetized, and placed in a prone position.
2. The provider makes an incision over the lumbar vertebral area or uses a posterolateral fusion approach, making incisions on the sides of the spine to expose the transverse process and facet joints.
3. Retractors are used to gain access to the vertebrae, and diseased cartilage and tissues are removed using powered tools.
4. The provider excises fragments from the cortical bone and the articular cartilage.
5. Laminectomy, discectomy, or both are performed to facilitate fusion.
6. Bone grafting material, such as bone chips, is applied to fill the gap created through laminectomy and/or discectomy.
7. Internal fixation devices like screws, plates, and nails are used to make the fusion durable.
8. Drains may be placed if needed.
9. The wound is irrigated with antibiotics and saline, and closed in layers.

4. Qualifying circumstances

Patients eligible to receive CPT code 22633 services are those who have been diagnosed with spinal instability, degenerative disc disease, spinal stenosis, spondylolisthesis, or other conditions that cause significant pain and disability in the lumbar spine. The procedure is typically recommended when conservative treatments, such as physical therapy, medications, and injections, have failed to provide adequate relief.

5. When to use CPT code 22633

It is appropriate to bill the 22633 CPT code when a provider performs a lumbar arthrodesis procedure using a combination of posterior or posterolateral techniques with posterior interbody techniques, including laminectomy and/or discectomy sufficient to prepare the interspace. This code is used for a single lumbar interspace, and additional interspaces should be reported using the add-on code +22634.

6. Documentation requirements

To support a claim for CPT 22633, the following information should be documented in the patient’s medical record:

• Diagnosis and medical necessity for the procedure
• Preoperative imaging studies and other diagnostic tests
• Details of the surgical procedure, including the techniques used, graft materials, and fixation devices
• Postoperative care instructions and follow-up plans
• Any complications or adverse events that occurred during or after the procedure

7. Billing guidelines

When billing for CPT code 22633, it is important to follow coding and payer guidelines to determine whether graft harvesting, laminectomy, and discectomy for decompression, and instrumentation codes may be reported separately for the specific case. Additionally, do not report CPT code 22633 with 22612 or 22630 for the same interspace.

8. Historical information

CPT 22633 was added to the Current Procedural Terminology system on January 1, 2012. In 2017, it was added to the Medicare Inpatient Only (IPO) list, and in 2020, it was removed from the IPO list.

9. Similar codes to CPT 22633

Five similar codes to CPT 22633 and how they differentiate are:

• CPT 22612: Describes a posterior lumbar arthrodesis without the combined techniques used in CPT 22633.
• CPT 22630: Represents a posterior lumbar interbody arthrodesis without the combined techniques used in CPT 22633.
• CPT 22558: Describes an anterior lumbar interbody arthrodesis, which is a different approach than the combined techniques in CPT 22633.
• CPT 22830: Represents a re-exploration of a previous spinal fusion site, which is not a primary fusion procedure like CPT 22633.
• +22634: This is an add-on code used to report each additional lumbar interspace when performed with CPT 22633.

10. Examples

Here are 10 detailed examples of CPT code 22633 procedures:

1. Lumbar arthrodesis for a patient with degenerative disc disease at L4-L5 using combined posterior and posterolateral techniques with posterior interbody technique, including laminectomy and discectomy.
2. Lumbar arthrodesis for a patient with spinal stenosis at L3-L4 using combined posterior and posterolateral techniques with posterior interbody technique, including laminectomy and discectomy.
3. Lumbar arthrodesis for a patient with spondylolisthesis at L5-S1 using combined posterior and posterolateral techniques with posterior interbody technique, including laminectomy and discectomy.
4. Lumbar arthrodesis for a patient with spinal instability at L2-L3 using combined posterior and posterolateral techniques with posterior interbody technique, including laminectomy and discectomy.
5. Lumbar arthrodesis for a patient with degenerative scoliosis at L4-L5 using combined posterior and posterolateral techniques with posterior interbody technique, including laminectomy and discectomy.
6. Lumbar arthrodesis for a patient with a herniated disc at L3-L4 using combined posterior and posterolateral techniques with posterior interbody technique, including laminectomy and discectomy.
7. Lumbar arthrodesis for a patient with a previous failed fusion at L5-S1 using combined posterior and posterolateral techniques with posterior interbody technique, including laminectomy and discectomy.
8. Lumbar arthrodesis for a patient with a spinal tumor at L2-L3 using combined posterior and posterolateral techniques with posterior interbody technique, including laminectomy and discectomy.
9. Lumbar arthrodesis for a patient with a spinal infection at L4-L5 using combined posterior and posterolateral techniques with posterior interbody technique, including laminectomy and discectomy.
10. Lumbar arthrodesis for a patient with a spinal fracture at L1-L2 using combined posterior and posterolateral techniques with posterior interbody technique, including laminectomy and discectomy.