How To Use CPT Code 22850

CPT 22850 describes the removal of a previously implanted nonsegmental spinal instrumentation device, such as a Harrington rod, from the posterior (back) portion of the spine. 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 22850?

CPT 22850 is used to describe the removal of a nonsegmental spinal instrumentation device, such as a Harrington rod, from the posterior aspect of the spine. This procedure is performed when the device needs to be removed due to infection, pain, rejection, or failure.

2. Official Description

The official description of CPT code 22850 is: ‘Removal of posterior nonsegmental instrumentation (e.g., Harrington rod).’ This code specifically refers to the removal of nonsegmental spinal instrumentation devices from the posterior aspect of the spine.

3. Procedure

During the procedure for CPT 22850, the patient is appropriately prepped and anesthetized. The provider makes a longitudinal incision over the affected area and carefully dissects the surrounding muscles and tissues to fully expose the instrumentation. The screws or other fixation points at either end of the nonsegmental instrumentation device are removed, and the device is detached. The provider then irrigates the area with antibiotics, checks for bleeding, removes any remaining instruments, and closes the incision.

4. Qualifying circumstances

CPT 22850 is performed when there is a need to remove a nonsegmental spinal instrumentation device from the posterior aspect of the spine. This may be due to various reasons, including infection, pain, rejection, or failure of the device. The procedure is typically performed by a qualified healthcare professional who has the necessary expertise in spinal surgeries.

5. When to use CPT code 22850

CPT code 22850 should be used when a nonsegmental spinal instrumentation device, such as a Harrington rod, needs to be removed from the posterior aspect of the spine. It is important to ensure that the documentation clearly supports the medical necessity for the removal and specifies the reason for the removal, such as infection, pain, rejection, or failure of the device.

6. Documentation requirements

To support a claim for CPT 22850, the healthcare professional must document the following information:

• Reason for the removal of the nonsegmental spinal instrumentation device
• Details of the procedure, including the approach used and any complications encountered
• Documentation of any additional procedures performed during the same operative session
• Any relevant preoperative and postoperative diagnoses
• Signature of the healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT 22850, it is important to ensure that the documentation supports the medical necessity for the procedure. The procedure should be reported with the appropriate diagnosis codes that justify the removal of the nonsegmental spinal instrumentation device. It is also important to follow any specific billing guidelines provided by the payer and to use the appropriate modifiers, if required.

8. Historical information

CPT 22850 was added to the Current Procedural Terminology system on January 1, 1990. There have been several updates and changes to the code over the years, including being added to the Inpatient Only (IPO) list in 2017 and then removed from the IPO list in 2021. However, as of 2022, it has been added back to the IPO list.

9. Similar codes to CPT 22850

There are several similar codes to CPT 22850 that describe different spinal instrumentation procedures. These include:

• CPT 22840: Removal of posterior nonsegmental instrumentation (e.g., CD Horizon Legacy, Moss-Miami); 1 to 3 vertebral segments
• CPT 22842: Removal of posterior nonsegmental instrumentation (e.g., CD Horizon Legacy, Moss-Miami); 4 to 7 vertebral segments
• CPT 22845: Removal of posterior nonsegmental instrumentation (e.g., CD Horizon Legacy, Moss-Miami); 8 or more vertebral segments
• CPT 22846: Removal of posterior segmental instrumentation (e.g., pedicle fixation) for spinal deformity, 1 to 3 vertebral segments
• CPT 22847: Removal of posterior segmental instrumentation (e.g., pedicle fixation) for spinal deformity, 4 to 7 vertebral segments

9. Examples

1. A patient with a previously implanted Harrington rod undergoes a removal procedure due to infection and pain in the posterior aspect of the spine.
2. A nonsegmental spinal instrumentation device is removed from the posterior aspect of the spine in a patient who experienced rejection and failure of the device.
3. A healthcare professional performs the removal of a Harrington rod from the posterior aspect of the spine in a patient who developed complications following the initial implantation.
4. A patient undergoes the removal of a nonsegmental spinal instrumentation device from the posterior aspect of the spine due to the failure of the device to provide the desired spinal stability.
5. A previously implanted Harrington rod is removed from the posterior aspect of the spine in a patient who experienced severe pain and discomfort.
6. A healthcare professional performs the removal of a nonsegmental spinal instrumentation device from the posterior aspect of the spine in a patient who developed an infection at the site of the implant.
7. A patient undergoes the removal of a Harrington rod from the posterior aspect of the spine due to the development of complications, such as nerve impingement and loss of function.
8. A nonsegmental spinal instrumentation device is removed from the posterior aspect of the spine in a patient who experienced rejection and allergic reactions to the implant.
9. A healthcare professional performs the removal of a previously implanted Harrington rod from the posterior aspect of the spine in a patient who developed instability and deformity.
10. A patient undergoes the removal of a nonsegmental spinal instrumentation device from the posterior aspect of the spine due to the failure of the device to provide the desired correction of the spinal deformity.