How To Use CPT Code 22634
CPT code 22634 describes a specific arthrodesis procedure performed on the spine, specifically the lumbar region. 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 22634?
CPT 22634 is a code used to describe a combined posterior or posterolateral technique with a posterior interbody technique for arthrodesis in the lumbar region of the spine. This procedure involves joining two additional adjoining lumbar vertebral bodies permanently, using a combination of approaches to access the operative site and achieve a better outcome. The purpose of this procedure is to prevent further damage or pain in the joint.
2. Official Description
The official description of CPT code 22634 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 each additional interspace (List separately in addition to code for primary procedure).’ This code should be used in conjunction with CPT code 22633, and it should not be reported with certain other codes for laminectomy performed on the same spinal interspace and vertebral segment.
3. Procedure
In the procedure for CPT code 22634, the healthcare provider performs a combination of techniques to achieve arthrodesis in the lumbar region of the spine. The provider accesses the operative site by making incisions over the spine or on the sides of the spine to expose the transverse process and facet joints. Retractors are used to gain access to the vertebrae. The provider removes diseased cartilage and tissues using powered tools and excises fragments from the cortical bone and articular cartilage. Laminectomy, discectomy, or both may be performed to prepare the interspace for fusion. Bone grafting material, such as bone chips, is applied to fill the gap created through laminectomy and/or discectomy. Internal fixation devices like screws, plates, and nails may be used to stabilize the fused vertebrae. The provider may also place drains if needed and irrigate the wound before closing it in layers.
4. Qualifying circumstances
CPT code 22634 is used for patients who require arthrodesis in the lumbar region of the spine. This procedure is typically performed on patients with conditions such as degenerative disc disease, spinal stenosis, or spondylolisthesis. The decision to perform arthrodesis is made based on the patient’s symptoms, imaging studies, and the failure of conservative treatment options. The provider must assess the patient’s condition and determine the need for arthrodesis before proceeding with the procedure.
5. When to use CPT code 22634
CPT code 22634 should be used when a healthcare provider performs a combined posterior or posterolateral technique with a posterior interbody technique for arthrodesis in the lumbar region of the spine. This code is used for each additional interspace and segment that requires arthrodesis. It is important to note that CPT code 22634 should be reported in conjunction with CPT code 22633, which represents the initial interspace.
6. Documentation requirements
To support a claim for CPT code 22634, the healthcare provider must document the following information:
- Patient’s diagnosis and the need for arthrodesis in the lumbar region
- Specific techniques used, including the approach and the type of interbody technique
- Date of the procedure
- Details of the procedure, including any additional procedures performed (e.g., laminectomy, discectomy)
- Specific vertebral levels involved
- Use of bone grafting material and any separately reportable grafts
- Use of internal fixation devices
- Use of drains, if applicable
- Details of wound irrigation and closure
7. Billing guidelines
When billing for CPT code 22634, it is important to ensure that the procedure meets the criteria for this code. The provider should report CPT code 22634 in conjunction with CPT code 22633 for the initial interspace. It is also important to follow coding and payer guidelines to determine if graft harvesting can be reported separately. Additionally, if laminectomy and discectomy are performed for decompression on the same interspace and vertebral segment as the arthrodesis, separate codes should be used.
8. Historical information
CPT code 22634 was added to the Current Procedural Terminology system on January 1, 2012. There have been some historical changes to the code, including a code change on January 1, 2022, which modified the description to include each additional interspace and segment. It was also previously listed as an Inpatient Only (IPO) procedure for Medicare, but it was removed from the IPO list in 2020.
9. Similar codes to CPT 22634
There are several similar codes to CPT code 22634 that are used to describe arthrodesis procedures on the spine. These include:
- CPT 22590: Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar
- CPT 22595: 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 22612: Arthrodesis, posterior or posterolateral technique, single level; lumbar
- CPT 22614: Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure)
- CPT 22630: Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression); lumbar
9. Examples
- A patient with degenerative disc disease undergoes a combined posterior technique with a posterior interbody technique for arthrodesis at the L4-L5 level.
