How To Use CPT Code 22818

CPT 22818 describes the surgical procedure known as kyphectomy, which involves the circumferential exposure of the spine and resection of one or two vertebral segments, including the body and posterior elements. 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 22818?

CPT 22818 is a code used to describe the surgical procedure known as kyphectomy. This procedure involves the circumferential exposure of the spine and the resection of one or two vertebral segments, including the body and posterior elements. Kyphectomy is performed to alleviate persistent pain caused by various spinal deformities, such as spina bifida or kyphosis.

2. Official Description

The official description of CPT code 22818 is: ‘Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and posterior elements) single or 2 segments.’

3. Procedure

The kyphectomy procedure involves several steps:

1. The provider makes a midline incision over the spinal deformity.
2. The provider dissects through the muscle and tissue until the foramina on both sides of the affected vertebrae are visible.
3. The provider dissects the dural sac and further dissects down to the intervertebral disk.
4. The provider removes the necessary vertebrae to correct the deformity.
5. The provider covers the resected vertebrae with the dural sac.
6. The provider applies bone grafting to the defect and uses instrumentation, such as wiring or plates, to stabilize the vertebrae.
7. The provider irrigates the wound and closes the incision.
8. The provider may apply a cast or other immobilization device.

4. Qualifying circumstances

Kyphectomy is performed on patients with spinal deformities, such as spina bifida or kyphosis, who experience persistent pain. The procedure is intended to alleviate this pain and improve the patient’s quality of life. It is important to note that bone grafting and spinal instrumentation, if performed, are reported separately.

5. When to use CPT code 22818

CPT code 22818 should be used when a provider performs a kyphectomy procedure, which involves the circumferential exposure of the spine and the resection of one or two vertebral segments, including the body and posterior elements. This code should be used for each segment resected during the procedure.

6. Documentation requirements

To support a claim for CPT code 22818, the provider must document the following information:

• Patient’s diagnosis and the need for kyphectomy
• Details of the procedure, including the specific vertebral segment(s) resected
• Date of the procedure
• Start and end time of the procedure
• Any additional procedures performed, such as bone grafting or spinal instrumentation
• Any complications or unexpected findings during the procedure
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 22818, ensure that the procedure performed meets the criteria described in the official description. It is important to report any additional procedures, such as bone grafting or spinal instrumentation, separately. Follow the appropriate coding guidelines and modifiers when reporting this code.

8. Historical information

CPT code 22818 was added to the Current Procedural Terminology system on January 1, 1998. It has undergone several changes, including being added to the Inpatient Only (IPO) list in 2017 and then removed from the IPO list in 2021. However, it was added back to the IPO list in 2022.

9. Similar codes to CPT 22818

There are several similar codes to CPT 22818 that describe other arthrodesis procedures for spine deformities. These codes include:

• CPT 22800: Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); cervical below C2
• CPT 22802: Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); cervical below C2, each additional interspace (List separately in addition to code for primary procedure)
• CPT 22804: Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic
• CPT 22808: Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar
• CPT 22810: Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar below L5-S1

9. Examples

1. A patient with severe kyphosis undergoes a kyphectomy procedure to correct the spinal deformity.
2. A patient with spina bifida experiences persistent pain and undergoes a kyphectomy procedure to alleviate the discomfort.
3. A provider performs a kyphectomy on a patient with a hunchback caused by kyphosis.
4. A patient with a spinal deformity undergoes a kyphectomy to improve their posture and alleviate pain.
5. A provider performs a kyphectomy on a patient with a congenital spinal deformity to improve their mobility and quality of life.
6. A patient with kyphosis undergoes a kyphectomy procedure to correct the abnormal curvature of their spine.
7. A provider performs a kyphectomy on a patient with a severe spinal deformity to alleviate pain and improve their overall function.
8. A patient with a hunchback caused by kyphosis undergoes a kyphectomy to improve their appearance and relieve discomfort.