Report add-on code 22845 for placement of spinal instrumentation across two or three vertebral segments during spinal surgery.
1. What Is CPT Code 22845?
CPT 22845 covers an add-on procedure performed during a primary spinal surgery such as arthrodesis or spinal fusion.
This procedure aims to correct a spinal deformity by placing spinal instrumentation at the front of the patient’s spine. The spinal instrumentation can be placed across two or three vertebral segments.
The CPT book describes add-on code 22845 as follows: “Anterior instrumentation; two to three vertebral segments.”
The 22845 CPT code procedure happens during primary spinal surgery.
The surgeon begins by looking for the vertebral segments before they create a passageway for the fixation screw through the first vertebral body and repeats this with one or two other segments.
Next, they place the screws and, in the meantime, avoid pressure on the patient’s dura which covers the spinal cord and nerves.
Then, the provider secures the rod, cable, or plate to the screws depending on the protocol required for installing the device. They continue the procedure by supplementing the fixation by applying cement material such as methyl methacrylate.
Finally, they create the desired shape of the rod by contouring them so they fit the instrumentation before continuing with the primary spinal procedure.
4. How To Use CPT 22845
CPT code 22845 is an add-on code and can not be billed alone. Use CPT 22845 in combination with the following CPT codes; CPT 63300 to CPT 63307, CPT 63170 to CPT 63290, CPT 63102, CPT 63101, CPT 63090, CPT 63087, CPT 63085, 63081, CPT 63077, CPT 63075, CPT 63064, CPT 63050 to CPT 63056, CPT 63045 CPT 63047, CPT 63040 to CPT 63042, CPT 63001 to CPT 63030, CPT 63001 to CPT 63030, CPT 22800 to CPT 22812, CPT 22634, CPT 22633, CPT 22630, CPT 22590 to CPT 22612, CPT 22548 to CPT 22558, CPT 22533, CPT 22532, CPT 22310 to CPT 22327, CPT 22220 to CPT 22224, CPT 22210 to CPT 22214, CPT 22207, CPT 22206, CPT 22110 to CPT 22114, or CPT 22100 to CPT 22102.
Ensure you understand the differences between the CPT codes for spinal instrumentation (CPT 22840 to CPT 22870).
Start with the approach for instrumentation (posterior or anterior) to identify the correct code for the procedure you are billing. Then, by counting the fixation points, you check if the procedure is nonsegmental or segmental.
The fixation is segmental if there is a distal and proximal point with one or more intervening fixation point(s). Finally, you confirm the removed vertebral portions and decide on the code that fits the procedure.
CPT 22845 needs to be billed with modifier 59 if the payer wants you to demonstrate that the provider performed the instrumentation at separate anatomic locations. But check the payer’s guidelines if they approve modifiers for spinal instrumentation services (not all do).