How To Use CPT Code 22857

CPT code 22857 describes the procedure of total disc arthroplasty (artificial disc) performed through an anterior approach on a single interspace in the lumbar region. 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 22857?

CPT 22857 is used to describe the surgical procedure known as total disc arthroplasty, which involves the replacement of a diseased or damaged intervertebral disc in the lumbar spine with an artificial disc. This procedure is performed through an anterior approach, meaning the surgeon accesses the spine from the front of the body.

2. Official Description

The official description of CPT code 22857 is: ‘Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression) single interspace, lumbar.’

3. Procedure

During the total disc arthroplasty procedure described by CPT 22857, the surgeon first makes an incision in the abdomen to access the lumbar spine. The organs and blood vessels are carefully moved aside to expose the targeted intervertebral disc. The surgeon then removes the diseased or damaged disc and prepares the interspace for the insertion of an artificial disc. The prosthetic disc is carefully placed in the prepared space, and the organs and blood vessels are repositioned. The incision is closed, completing the procedure.

4. Qualifying circumstances

CPT 22857 is used for patients who require total disc arthroplasty in the lumbar region. This procedure is typically performed on individuals with conditions such as degenerative disc disease or disc herniation that have not responded to conservative treatments. It is important to note that CPT 22857 should not be reported if other specific codes, such as 22558, 22845, 22853, 22854, 22859, or 49010, have already been used to describe procedures performed at the same level.

5. When to use CPT code 22857

CPT code 22857 should be used when a surgeon performs total disc arthroplasty through an anterior approach on a single interspace in the lumbar spine. It is important to ensure that the procedure meets the specific criteria outlined in the code description, including the use of an artificial disc and the absence of decompression as the primary purpose of the surgery.

6. Documentation requirements

To support a claim for CPT 22857, the surgeon must document the following information:

• Patient’s diagnosis and the medical necessity for total disc arthroplasty
• Details of the procedure, including the specific interspace and the use of an artificial disc
• Date of the surgery
• Incision approach (anterior)
• Any additional procedures performed during the same surgical session
• Signature of the performing surgeon

7. Billing guidelines

When billing for CPT 22857, it is important to ensure that the procedure meets the specific criteria outlined in the code description. Additionally, CPT 22857 should not be reported if other specific codes for procedures performed at the same level have already been used. It is recommended to review the documentation and guidelines provided by the payer to ensure accurate and appropriate billing.

8. Historical information

CPT 22857 was added to the Current Procedural Terminology system on January 1, 2007. Since its addition, there have been several historical changes to the code, including updates to the code description and its inclusion or exclusion from the Inpatient Only (IPO) list for Medicare reimbursement purposes.

9. Similar codes to CPT 22857

There are several similar codes to CPT 22857 that describe different procedures or variations of total disc arthroplasty. These codes include:

• CPT 22860: This code is used for total disc arthroplasty performed on a second lumbar interspace during the same surgical session.
• Other similar codes may exist, but it is important to consult the most up-to-date code set and documentation guidelines for accurate coding.

9. Examples

1. A patient with degenerative disc disease undergoes total disc arthroplasty at the L4-L5 interspace using an artificial disc.
2. A surgeon performs total disc arthroplasty through an anterior approach at the L3-L4 interspace to address a herniated disc.
3. An individual with chronic lower back pain undergoes total disc arthroplasty at the L5-S1 interspace to improve mobility and alleviate symptoms.
4. A patient with a history of failed conservative treatments undergoes total disc arthroplasty at the L2-L3 interspace to address disc degeneration.
5. A surgeon performs total disc arthroplasty at the L1-L2 interspace using an artificial disc to treat a patient with recurrent disc herniation.
6. An individual with significant disc degeneration undergoes total disc arthroplasty at the L5-L6 interspace to restore spinal stability.
7. A surgeon performs total disc arthroplasty through an anterior approach at the L4-L5 interspace to address discogenic back pain.
8. An individual with a history of trauma undergoes total disc arthroplasty at the L3-L4 interspace to address disc displacement.
9. A patient with a previous lumbar fusion undergoes total disc arthroplasty at the L2-L3 interspace to address adjacent segment disease.
10. A surgeon performs total disc arthroplasty at the L5-S1 interspace using an artificial disc to treat a patient with disc degeneration and radiculopathy.