How To Use CPT Code 22846

CPT 22846 describes the placement of anterior instrumentation across four to seven 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 22846?

CPT 22846 is used to describe the placement of anterior instrumentation across four to seven vertebral segments during a spinal surgery. This code is an add-on code and should be reported in addition to the primary procedure code for the spinal surgery. Anterior instrumentation involves the application of spinal fixation devices to the front of the spine to correct spinal deformities.

2. Official Description

The official description of CPT code 22846 is: ‘Anterior instrumentation 4 to 7 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

During a spinal surgery, the healthcare provider identifies the target vertebral segments and prepares a passageway for the fixation screw through the vertebral body. The provider then places screws in each vertebral body to be internally fixed, taking care to avoid pressure on the spinal cord and nerves. The plate, rod, or cable is secured to the screws according to the specific device’s protocol. Hooks may be applied to hold the plate at its anterior element, and a cement material, such as methyl methacrylate, may be used to supplement the fixation. The provider contours the rods to give the desired shape to the instrumentation. The primary procedure is then continued to completion, and the wound is closed.

4. Qualifying circumstances

CPT 22846 is used when anterior instrumentation is performed across four to seven vertebral segments during a spinal surgery. This procedure is typically done to correct spinal deformities and requires the use of spinal fixation devices applied to the front of the spine. It is important to note that CPT 22846 should be reported in conjunction with the primary procedure code for the spinal surgery.

5. When to use CPT code 22846

CPT code 22846 should be used when the healthcare provider performs anterior instrumentation across four to seven vertebral segments during a spinal surgery. This code is an add-on code and should be reported in addition to the primary procedure code for the spinal surgery.

6. Documentation requirements

To support a claim for CPT 22846, the healthcare provider must document the following information:

• Identification of the target vertebral segments
• Description of the specific fixation devices used
• Details of the placement of screws and other fixation components
• Use of any additional materials, such as cement, for supplementation
• Contouring of the rods to achieve the desired shape of the instrumentation
• Completion of the primary procedure and closure of the wound

7. Billing guidelines

When billing for CPT 22846, ensure that the procedure involves the placement of anterior instrumentation across four to seven 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 follow the specific guidelines and requirements of the payer when reporting CPT 22846.

8. Historical information

CPT 22846 was added to the Current Procedural Terminology system on January 1, 1996. There have been several historical changes to the code, including code changes in 2008 and Medicare changes in 2017 and 2022.

9. Similar codes to CPT 22846

There are several similar codes to CPT 22846 that are used to describe different types of spinal instrumentation procedures. Some examples include:

• CPT 22840: Anterior instrumentation 2 to 3 vertebral segments
• CPT 22842: Anterior instrumentation 4 to 7 vertebral segments; each additional vertebral segment (List separately in addition to code for primary procedure)
• CPT 22845: Anterior instrumentation 2 to 3 vertebral segments; each additional vertebral segment (List separately in addition to code for primary procedure)
• CPT 22850: Posterior non-segmental instrumentation (e.g., Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure)
• CPT 22852: Posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure)

9. Examples

1. A patient undergoes a spinal fusion surgery for the correction of scoliosis. The healthcare provider performs anterior instrumentation across six vertebral segments during the procedure. CPT code 22846 should be reported in addition to the primary procedure code for the spinal fusion.
2. During a spinal surgery, the healthcare provider places anterior instrumentation across five vertebral segments to correct a spinal deformity. CPT code 22846 should be reported along with the primary procedure code for the spinal surgery.
3. A patient undergoes a spinal fusion surgery for the treatment of spondylolisthesis. The healthcare provider performs anterior instrumentation across four vertebral segments during the procedure. CPT code 22846 should be reported in conjunction with the primary procedure code for the spinal fusion.
4. During a spinal surgery, the healthcare provider places anterior instrumentation across seven vertebral segments to correct a spinal deformity. CPT code 22846 should be reported along with the primary procedure code for the spinal surgery.
5. A patient undergoes a spinal fusion surgery for the correction of kyphosis. The healthcare provider performs anterior instrumentation across six vertebral segments during the procedure. CPT code 22846 should be reported in addition to the primary procedure code for the spinal fusion.
6. During a spinal surgery, the healthcare provider places anterior instrumentation across four vertebral segments to correct a spinal deformity. CPT code 22846 should be reported along with the primary procedure code for the spinal surgery.