How To Use CPT Code 22844

CPT code 22844 describes the placement of posterior segmental instrumentation across 13 or more vertebral segments during a spinal surgery. 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 22844?

CPT 22844 is used to describe the placement of posterior segmental instrumentation across 13 or more vertebral segments during a spinal surgery. This code is used when the provider uses pedicle fixation, dual rods with multiple hooks and sublaminar wires to correct a spinal deformity. The instrumentation is placed at the back of the spine to provide stability and support to the affected vertebral segments.

2. Official Description

The official description of CPT code 22844 is: ‘Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires) 13 or more vertebral segments (List separately in addition to code for primary procedure).’ This code should be used in conjunction with the primary procedure code for the spinal surgery.

3. Procedure

The procedure for CPT 22844 involves the following steps:

1. The patient is appropriately prepped and anesthetized for the spinal surgery.
2. The provider identifies the target segments where the posterior segmental instrumentation needs to be placed.
3. The surrounding tissues and ligaments are detached to gain access to the vertebral segments.
4. The provider drills the posterior cortex, or bony covering, directly posterior to the pedicle.
5. Using imaging guidance, the provider enters the pedicle and places screws through the pedicle into the vertebral body on each side of each vertebra to be segmentally fixed.
6. Hooks and clamps may be applied near transverse processes and laminae at the chosen vertebrae for additional stability.
7. The provider bends the rod or plate to achieve the desired shape for the spine and attaches it to the segmental fixation at each segment with nuts or screws.
8. The alignment of the instrumentation is checked using imaging.
9. The provider then continues with the primary procedure to complete the spinal surgery and closes the wound.

4. Qualifying circumstances

CPT 22844 is performed on patients who require correction of a spinal deformity across 13 or more vertebral segments. The procedure is typically performed during a spinal fusion or arthrodesis surgery. The patient must meet the criteria for the primary procedure and have a documented need for posterior segmental instrumentation to stabilize and support the affected vertebral segments.

5. When to use CPT code 22844

CPT code 22844 should be used when the provider performs posterior segmental instrumentation across 13 or more vertebral segments during a spinal surgery. This code should be reported in addition to the primary procedure code for the spinal surgery. It is important to ensure that the documentation clearly supports the use of posterior segmental instrumentation and specifies the number of vertebral segments involved.

6. Documentation requirements

To support a claim for CPT 22844, the provider must document the following information:

• Documentation of the need for posterior segmental instrumentation to correct the spinal deformity
• Identification of the specific vertebral segments where the instrumentation is placed
• Description of the type of instrumentation used, such as pedicle fixation, dual rods, hooks, and sublaminar wires
• Details of the procedure, including the steps performed and any additional techniques used
• Documentation of the primary procedure performed in conjunction with posterior segmental instrumentation
• Any complications or challenges encountered during the procedure
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 22844, it is important to ensure that the documentation supports the use of posterior segmental instrumentation across 13 or more vertebral segments. This code should be reported in addition to the primary procedure code for the spinal surgery. It is crucial to follow the coding guidelines and use the appropriate primary procedure code based on the specific surgical technique performed.

It is also important to note that CPT 22844 should not be reported with certain codes, such as those for anterior spinal procedures or procedures involving a smaller number of vertebral segments. It is essential to review the coding guidelines and documentation requirements to ensure accurate and appropriate billing for CPT 22844.

8. Historical information

CPT 22844 was added to the Current Procedural Terminology system on January 1, 1996. Since its addition, there have been several historical changes to the code, including code changes in 2008 and Medicare changes in 2017, 2021, and 2022. These changes have impacted the reporting and reimbursement of CPT 22844 for certain settings and services.

9. Similar codes to CPT 22844

There are several similar codes to CPT 22844 that describe spinal instrumentation procedures on the vertebral column. These codes include:

• CPT 22840: Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires) 3 to 6 vertebral segments
• CPT 22842: Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires) 7 to 12 vertebral segments
• CPT 22845: Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires) 1 vertebral segment
• CPT 22846: Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires) 2 vertebral segments
• CPT 22847: Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires) 3 to 6 vertebral segments

9. Examples

1. A patient with severe scoliosis undergoes a spinal fusion surgery with posterior segmental instrumentation across 15 vertebral segments.
2. A patient with degenerative disc disease undergoes a lumbar fusion surgery with posterior segmental instrumentation across 14 vertebral segments.