How To Use CPT Code 22845

CPT 22845 refers to the anterior instrumentation of 2 to 3 vertebral segments during spinal surgery. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 22845.

1. What is CPT 22845?

CPT 22845 is a medical code used to describe the anterior instrumentation of 2 to 3 vertebral segments during spinal surgery. This code is used by medical coders and billers to accurately document and bill for this specific procedure. The anterior instrumentation is performed to correct spinal deformities and stabilize the spine during the course of a spinal surgery, such as spinal fusion or arthrodesis.

2. 22845 CPT code description

The official description of CPT code 22845 is: “Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure)”.

3. Procedure

1. The patient is appropriately prepped and anesthetized for spinal surgery.
2. The provider identifies the target vertebral segments during the spinal surgery.
3. A passageway for the fixation screw is prepared through the vertebral body.
4. Screws are placed in each vertebral body to be internally fixed.
5. The provider takes care to avoid pressure on the dura, the covering of the spinal cord, and the spinal nerves.
6. The plate, rod, or cable is secured to the screws according to the protocol of that particular device.
7. Some hooks may be applied to hold the plate at its anterior element.
8. A cement material, like methyl methacrylate, may be applied to supplement the fixation.
9. The rods are contoured to give the desired shape to the instrumentation.
10. The provider then continues the primary procedure to its completion, closing the wound.

4. Qualifying circumstances

Patients eligible to receive CPT 22845 services are those who require anterior instrumentation of 2 to 3 vertebral segments during spinal surgery. This may include patients with spinal deformities, instability, or other conditions that necessitate the use of spinal instrumentation for stabilization and support. The decision to perform this procedure is based on the patient’s medical history, physical examination, and imaging studies, as well as the surgeon’s clinical judgment.

5. When to use CPT code 22845

It is appropriate to bill the 22845 CPT code when the provider performs anterior instrumentation of 2 to 3 vertebral segments during spinal surgery. This code should be used in conjunction with the primary procedure code for the spinal surgery being performed. CPT 22845 is an add-on code and must be reported with an appropriate primary procedure.

6. Documentation requirements

To support a claim for CPT 22845, the following information should be documented in the patient’s medical record:

• Indication for the spinal surgery and the need for anterior instrumentation of 2 to 3 vertebral segments.
• Details of the surgical procedure, including the approach, type of instrumentation used, and the specific vertebral segments involved.
• Intraoperative findings and any complications encountered during the procedure.
• Postoperative care plan and follow-up instructions for the patient.

7. Billing guidelines

When billing for CPT code 22845, it is important to follow the specific guidelines and rules set forth by the payer. Some payers may require the use of specific modifiers to demonstrate that the provider performed the instrumentation at separate anatomic locations. Additionally, it is essential to confirm the removal of vertebral portions and the difference between segments and levels. Proper documentation and coding are crucial to ensure accurate reimbursement for the services provided.

8. Historical information

CPT 22845 was added to the Current Procedural Terminology system on January 1, 1990. The code was changed on January 1, 2008, with the previous descriptor being “Anterior instrumentation; 2 to 3 vertebral segments”.

9. Similar codes to CPT 22845

Five similar codes to CPT 22845 and how they differentiate are:

1. CPT 22840: This code refers to posterior non-segmental instrumentation, whereas CPT 22845 is for anterior instrumentation.
2. CPT 22842: This code is for posterior segmental instrumentation involving 3 or more vertebral segments, while CPT 22845 involves 2 to 3 vertebral segments.
3. CPT 22846: This code describes anterior segmental instrumentation involving 4 or more vertebral segments, in contrast to CPT 22845, which involves 2 to 3 segments.
4. CPT 22847: This code is for posterior non-segmental instrumentation with the insertion of interbody device(s), which is not included in CPT 22845.
5. CPT 22848: This code refers to anterior interbody biomechanical device placement, which is not part of the CPT 22845 procedure.

10. Examples

Here are 10 detailed examples of CPT code 22845 procedures:

1. Anterior instrumentation of 2 vertebral segments during a cervical spinal fusion for degenerative disc disease.
2. Anterior instrumentation of 3 vertebral segments during a thoracic spinal fusion for scoliosis correction.
3. Anterior instrumentation of 2 vertebral segments during a lumbar spinal fusion for spondylolisthesis.
4. Anterior instrumentation of 3 vertebral segments during a spinal fusion for spinal stenosis.
5. Anterior instrumentation of 2 vertebral segments during a spinal fusion for vertebral fracture stabilization.
6. Anterior instrumentation of 3 vertebral segments during a spinal fusion for kyphosis correction.
7. Anterior instrumentation of 2 vertebral segments during a spinal fusion for spinal instability due to tumor.
8. Anterior instrumentation of 3 vertebral segments during a spinal fusion for spinal deformity secondary to infection.
9. Anterior instrumentation of 2 vertebral segments during a spinal fusion for revision of a previous fusion.
10. Anterior instrumentation of 3 vertebral segments during a spinal fusion for correction of a failed previous fusion.