How To Use CPT Code 22830

CPT 22830 describes the exploration of a prior spinal fusion, or arthrodesis, to assess the status of the spinal bone. 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 22830?

CPT 22830 is used to describe the exploration of a prior spinal fusion, also known as arthrodesis. This procedure is performed to assess the status of the spinal bone after fusion and to ensure that the bones and surrounding structures are stabilized. The provider makes an incision over the previously fused vertebrae, confirms the complete bonding of the fusion, and may adjust or replace spinal instrumentation if necessary. The area is irrigated, checked for bleeding, any instruments are removed, and the incision is closed in layers.

2. Official Description

The official description of CPT code 22830 is: ‘Exploration of a prior spinal fusion, including dissection to the bone, removal of any instrumentation, and closure of the incision.’

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision over the vertebrae that were previously fused.
3. The provider dissects down to the bone to access the fused area.
4. The provider confirms that the fusion has bonded completely and ensures the stability of the bones and surrounding structures.
5. If necessary, the provider may adjust or replace spinal instrumentation.
6. The area is irrigated and checked for bleeding.
7. Any instruments are removed.
8. The incision is closed in layers.

4. Qualifying circumstances

CPT 22830 is performed when there is a need to explore a prior spinal fusion to assess the status of the fusion and stabilize the bones and surrounding structures. This procedure may be necessary in cases where there is a suspected failed fusion, damage or rejection of spinal instrumentation, or the need for further reconstruction, including arthrodesis. It is important to check with individual payers regarding which additional procedures can be reported with CPT 22830 during exploration, as Medicare or private insurer rules may vary.

5. When to use CPT code 22830

CPT code 22830 should be used when the provider performs an exploration of a prior spinal fusion without the need for removal or further reconstruction, including arthrodesis. It is important to reserve this code for instances where exploration is the primary focus of the procedure and does not involve additional major interventions.

6. Documentation requirements

To support a claim for CPT 22830, the provider must document the following information:

• Reason for the exploration of the prior spinal fusion
• Details of the procedure, including the incision, dissection, confirmation of fusion bonding, stability assessment, and any adjustments or replacements of spinal instrumentation
• Confirmation of complete exploration without the need for removal or further reconstruction
• Date of the procedure
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 22830, ensure that the procedure meets the criteria for exploration of a prior spinal fusion without the need for removal or further reconstruction. It is important to review individual payer policies regarding reporting additional procedures with CPT 22830. If removal of spinal instrumentation is performed as part of the exploration, it should not be separately reported. However, if the removal is due to a failed fusion, it may be accompanied by fusion exploration (CPT 22830).

8. Historical information

CPT 22830 was added to the Current Procedural Terminology system on January 1, 1990. There have been several changes to its status as an inpatient-only (IPO) procedure, with removal and re-addition to the IPO list in subsequent years. It is important to stay updated on the latest Medicare and private insurer guidelines regarding the coverage and reporting of CPT 22830.

9. Examples

1. A patient undergoes exploration of a prior spinal fusion to assess the fusion’s status and ensure stability.
2. A provider performs an exploration of a failed spinal fusion, removing instrumentation and assessing the need for further reconstruction.
3. During a procedure, the provider explores a prior spinal fusion without the need for removal or additional reconstruction.
4. A patient undergoes exploration of a prior spinal fusion to assess the fusion’s status and stability, with no further interventions required.
5. A provider performs an exploration of a spinal fusion, confirming complete bonding and stability without the need for removal or further reconstruction.
6. During a procedure, the provider explores a prior spinal fusion, ensuring the fusion’s integrity and stability.
7. A patient undergoes exploration of a failed spinal fusion, with removal of instrumentation and subsequent reconstruction.
8. A provider performs an exploration of a prior spinal fusion, adjusting spinal instrumentation to improve stability.
9. During a procedure, the provider explores a prior spinal fusion, confirming complete bonding and stability without the need for removal or further reconstruction.