How To Use CPT Code 22858

CPT code 22858 describes a specific surgical procedure known as total disc arthroplasty (artificial disc) performed on the cervical spine. This article will provide a comprehensive overview of CPT code 22858, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of when to use CPT code 22858.

1. What is CPT Code 22858?

CPT code 22858 is used to describe a surgical procedure called total disc arthroplasty (artificial disc) performed on the cervical spine. This procedure involves the removal of a painful degenerated disc and its replacement with an artificial mobile disc, which helps restore normal movement and function to the affected area. Additionally, the provider may also remove bone spurs or growths that develop on the upper or lower edges of the vertebrae to alleviate pressure on the nerve root or spinal cord.

2. Official Description

The official description of CPT code 22858 is: ‘Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection) second level, cervical (List separately in addition to code for primary procedure).’ This code should be used in conjunction with CPT code 22856 for the primary procedure.

3. Procedure

During the procedure, the provider makes an incision in the anterior neck and carefully dissects through the tissue, ensuring the protection of vital structures such as the carotid vessels, esophagus, and trachea. The prevertebral space is exposed, and retractors are used to hold back the surrounding tissues. The provider then incises the disc space and removes part or the majority of the vertebral body between the involved discs. This is done using an operating microscope and microdissection techniques to clear the disc space.

The bulging disc and bone spurs are removed to decompress the nerve root, reducing pressure and alleviating pain. The provider guides a drill into the disc space to create a clear space for the placement of the artificial disc. The artificial disc is then inserted to replace the removed discs. In some cases, a plate may be placed on the front of the adjacent vertebral bodies for additional support. This procedure is commonly performed when there are multilevel disc herniations, spurs, or spinal cord compression.

After completing the necessary steps, the provider ensures hemostasis and closes the incision by suturing the soft tissues in layers. It is important to note that CPT code 22858 is applicable for a second level procedure.

4. Qualifying circumstances

CPT code 22858 is used for patients who require total disc arthroplasty (artificial disc) on the cervical spine. This procedure is typically performed on patients with degenerative disc disease, herniated discs, or spinal cord compression. The decision to perform this procedure is made based on the patient’s clinical presentation and imaging findings.

5. When to use CPT code 22858

CPT code 22858 should be used when a provider performs total disc arthroplasty (artificial disc) on the cervical spine as a second level interspace procedure. It is important to note that this code should be reported in addition to the primary procedure code, which is represented by CPT code 22856.

6. Documentation requirements

When reporting CPT code 22858, the provider must ensure that the documentation includes the following information:

• Patient’s diagnosis justifying the need for total disc arthroplasty
• Specific details of the procedure performed, including the removal of the degenerated disc, placement of the artificial disc, and any additional procedures such as osteophytectomy
• Date of the procedure
• Any complications or unexpected findings
• Signature of the performing provider

7. Billing guidelines

When billing for CPT code 22858, it is important to ensure that the procedure meets the specific criteria outlined in the code description. Additionally, CPT code 22858 should only be reported in conjunction with the primary procedure code, CPT code 22856. Payers may not reimburse for CPT code 22858 if it is reported without an appropriate primary code.

8. Historical information

CPT code 22858 was added to the Current Procedural Terminology system on January 1, 2015. There have been no updates or changes to the code since its addition.

9. Similar codes to CPT code 22858

There are no similar codes to CPT code 22858 within the range of spinal instrumentation procedures on the spine (vertebral column) (22840-22870).

9. Examples

1. A patient with degenerative disc disease undergoes total disc arthroplasty (artificial disc) on the cervical spine at the C5-C6 level.
2. A patient with a herniated disc in the cervical spine undergoes total disc arthroplasty (artificial disc) at the C4-C5 level.
3. A patient with spinal cord compression due to disc degeneration undergoes total disc arthroplasty (artificial disc) at the C6-C7 level.
4. A patient with multilevel disc herniations in the cervical spine undergoes total disc arthroplasty (artificial disc) at the C3-C4 and C7-T1 levels.
5. A patient with osteophytes causing nerve root compression undergoes total disc arthroplasty (artificial disc) at the C2-C3 level.
6. A patient with persistent neck pain and limited mobility undergoes total disc arthroplasty (artificial disc) at the C6-C7 level.
7. A patient with cervical disc degeneration and radiculopathy undergoes total disc arthroplasty (artificial disc) at the C5-C6 level.
8. A patient with cervical disc herniation and myelopathy undergoes total disc arthroplasty (artificial disc) at the C4-C5 level.
9. A patient with cervical disc degeneration and spinal cord compression undergoes total disc arthroplasty (artificial disc) at the C3-C4 level.
10. A patient with cervical disc herniation and radiculopathy undergoes total disc arthroplasty (artificial disc) at the C6-C7 level.