How To Use CPT Code 22868

CPT code 22868 describes the insertion of an interlaminar/interspinous process stabilization/distraction device without fusion, including image guidance when performed, with open decompression at the second level of the lumbar 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 22868?

CPT 22868 is a code used to describe the insertion of an interlaminar/interspinous process stabilization/distraction device without fusion at the second level of the lumbar spine. This procedure involves the use of a device to restrict painful motion or open up the neural foramina, relieving pressure on the nerve roots. It is important to note that this code should be reported in conjunction with the primary procedure code, 22867, and cannot be reported with certain other codes.

2. Official Description

The official description of CPT code 22868 is: ‘Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar second level (List separately in addition to code for primary procedure).’ It is important to note that this code should be used in conjunction with code 22867.

3. Procedure

The procedure for CPT code 22868 involves the insertion of an interlaminar/interspinous process stabilization/distraction device without fusion at the second level of the lumbar spine. The provider will make an incision and dissect down through the tissues to access the spinous processes. The muscles on both sides of the spinous processes are then elevated and dissected off the laminae. The provider may use image guidance to confirm the level of stenosis. The correct implant size is determined, and bone or ligament may need to be removed to make room for the device. The device is then inserted between the spinous processes and locked in place. The provider will remove all retractors, control bleeding, reapproximate the tissues, close the incision with sutures, and apply a sterile dressing over the wound.

4. Qualifying circumstances

CPT code 22868 is used for patients who require interlaminar/interspinous process stabilization/distraction at the second level of the lumbar spine. This procedure is typically performed to restrict painful motion or relieve pressure on the nerve roots. It is important to note that this code should not be reported with certain other codes, such as those for fusion procedures or other specific spinal instrumentation procedures.

5. When to use CPT code 22868

CPT code 22868 should be used when the provider performs the insertion of an interlaminar/interspinous process stabilization/distraction device without fusion at the second level of the lumbar spine. This code should be reported in conjunction with the primary procedure code, 22867. It is important to review the documentation and ensure that the procedure meets the specific criteria outlined in the code description.

6. Documentation requirements

To support a claim for CPT code 22868, the provider must document the following information:

• Patient’s diagnosis and the need for interlaminar/interspinous process stabilization/distraction at the second level of the lumbar spine
• Confirmation of the level of stenosis using image guidance, if performed
• Details of the procedure, including the specific device used and any bone or ligament removal
• Date of the procedure
• Signature of the provider

7. Billing guidelines

When billing for CPT code 22868, it is important to ensure that the procedure meets the specific criteria outlined in the code description. This code should be reported in conjunction with the primary procedure code, 22867. It should not be reported with certain other codes, such as those for fusion procedures or other specific spinal instrumentation procedures. It is recommended to review payer policies and guidelines to ensure accurate and appropriate billing.

8. Historical information

CPT code 22868 was added to the Current Procedural Terminology system on January 1, 2017. There have been no updates to the code since its addition.

9. Similar codes to CPT 22868

There are several similar codes to CPT code 22868 that may be used for different procedures or levels of the lumbar spine. These include:

• CPT 22867: Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar single level
• CPT 22532: Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar
• CPT 22533: Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; each additional lumbar interspace (List separately in addition to code for primary procedure)
• CPT 22534: Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar
• CPT 22558: Arthrodesis, posterior or posterolateral technique, single level; lumbar

9. Examples

1. A patient with lumbar spinal stenosis undergoes an open decompression at the second level of the lumbar spine, with the insertion of an interlaminar/interspinous process stabilization/distraction device without fusion.
2. A provider performs an open decompression at the second level of the lumbar spine and inserts an interlaminar/interspinous process stabilization/distraction device without fusion to restrict painful motion and relieve pressure on the nerve roots.
3. During a surgical procedure, a device is inserted at the second level of the lumbar spine to stabilize the interlaminar/interspinous process and relieve pressure on the nerve roots.
4. A patient with lumbar spinal stenosis undergoes an open decompression at the second level of the lumbar spine, with the insertion of an interlaminar/interspinous process stabilization/distraction device without fusion to alleviate symptoms.