How To Use CPT Code 22848

CPT code 22848 describes the attachment of the lower end of a spinal fixation device to the pelvic bones, excluding the sacrum, 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 22848?

CPT 22848 is used to describe the attachment of the lower end of a spinal fixation device to the pelvic bones, specifically the wings of the ilium, during a spinal surgery. This code is used when the provider is performing a spinal fusion or arthrodesis and needs to stabilize the spine by connecting it to the pelvis.

2. Official Description

The official description of CPT code 22848 is: ‘Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum (List separately in addition to code for primary procedure)’

3. Procedure

During a spinal surgery with instrumentation, the provider exposes the bottom of the spine and dissects between the subcutaneous fat and fascia to expose the wings of the ilium. The provider then inserts a guide pin inside the wing of the ilium, avoiding the sacroiliac joint. Contouring the rods to provide proper shape to the pelvic segments, the provider introduces the pelvic section of the rod to the iliac insertion hole and taps it into the wing of the ilium with a rod pusher. The pelvic fixation device is then linked to the spinal rod by crosslinking instruments. This procedure is performed on both sides of the pelvis, and the provider continues with the primary procedure, closing the wound.

4. Qualifying circumstances

CPT 22848 is used when the provider attaches the lower end of a spinal fixation device to the pelvic bones, excluding the sacrum, during a spinal surgery. This procedure is typically performed when there is a need for greater stabilization of the spine, such as in cases of spinal fusion or arthrodesis. It is important to note that CPT 22848 should be used in conjunction with the primary procedure code for the spinal surgery.

5. When to use CPT code 22848

CPT code 22848 should be used when the provider is performing a spinal surgery and needs to attach the lower end of a spinal fixation device to the pelvic bones, excluding the sacrum. This code should be reported in addition to the primary procedure code for the spinal surgery.

6. Documentation requirements

To support a claim for CPT 22848, the provider must document the following information:

• Indication for the spinal surgery and the need for pelvic fixation
• Description of the procedure performed, including the attachment of the spinal fixation device to the pelvic bones
• Date of the surgery
• Any complications or additional procedures performed
• Signature of the provider

7. Billing guidelines

When billing for CPT 22848, ensure that the procedure meets the criteria for pelvic fixation and is performed in conjunction with a primary procedure for spinal surgery. It is important to follow the specific guidelines provided by the payer regarding the use of modifiers and reporting of additional codes. Modifier 59, Distinct procedural service, may be used to indicate that the pelvic fixation was performed at a separate anatomical location.

8. Historical information

CPT 22848 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 its addition and removal from the Inpatient Only (IPO) list for Medicare patients in 2017 and 2021 respectively.

9. Similar codes to CPT 22848

There are several similar codes to CPT 22848 that describe different spinal instrumentation procedures on the spine. Some of these codes include:

• CPT 22840: Anterior instrumentation of the spine
• CPT 22842: Anterior instrumentation of the spine, two to three vertebral segments
• CPT 22845: Posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments
• CPT 22850: Posterior non-segmental instrumentation (e.g., Harrington rod technique, pedicle fixation across the transverse process, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation); 1 to 3 vertebral segments
• CPT 22852: Posterior non-segmental instrumentation (e.g., Harrington rod technique, pedicle fixation across the transverse process, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation); 4 to 6 vertebral segments

9. Examples

1. A patient undergoes a spinal fusion surgery, and during the procedure, the provider attaches the lower end of a spinal fixation device to the wings of the ilium to provide additional stability to the spine.
2. During a spinal arthrodesis, the provider performs pelvic fixation by attaching the lower end of a spinal fixation device to the pelvic bones, excluding the sacrum.
3. A patient with severe spinal instability undergoes a complex spinal surgery, and the provider utilizes pelvic fixation to enhance the fusion and stabilization of the spine.
4. As part of a multi-level spinal fusion surgery, the provider performs pelvic fixation by attaching the lower end of a spinal fixation device to the wings of the ilium.
5. During a revision spinal surgery, the provider incorporates pelvic fixation to address the patient’s recurrent spinal instability.
6. A patient with degenerative disc disease undergoes a spinal fusion surgery, and the provider utilizes pelvic fixation to improve the long-term stability of the spine.
7. During a corrective spinal surgery for scoliosis, the provider performs pelvic fixation to achieve optimal alignment and stability of the spine.
8. A patient with spinal trauma undergoes a complex spinal surgery, and the provider utilizes pelvic fixation to enhance the overall stability and fusion of the spine.
9. As part of a multi-level spinal arthrodesis, the provider performs pelvic fixation to reinforce the fusion and stability of the spine.