How To Use CPT Code 22869

CPT code 22869 describes the insertion of an interlaminar/interspinous process stabilization/distraction device in the lumbar spine, without open decompression or fusion. 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 22869?

CPT 22869 is used to describe the insertion of an interlaminar/interspinous process stabilization/distraction device in the lumbar spine. This procedure is performed without open decompression or fusion and is used to restrict painful motion or relieve pressure on the nerve roots by stabilizing or distracting the neural foramina.

2. Official Description

The official description of CPT code 22869 is: ‘Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar single level.’

3. Procedure

1. The provider makes a small incision in the skin over the middle of the lower back at the appropriate lumbar level.
2. The provider dissects down through the tissues and lifts and retracts the muscles on both sides of the spinous processes.
3. The provider may use image guidance to confirm the level of stenosis.
4. The provider sizes the space to determine the correct implant size and may need to remove bone or ligament to make room for the device.
5. The provider inserts a distraction device between the spinous processes and locks it in place, or alternatively, inserts an interlaminar device.
6. The device restricts extension and enlarges the openings (foramina) through which the nerves and vessels exit the spinal canal, relieving pressure on the nerve roots.
7. The provider removes all retractors, controls bleeding, reapproximates the tissues, closes the incision with sutures, and applies a sterile dressing over the wound.

4. Qualifying circumstances

CPT 22869 is performed on patients with lumbar spinal stenosis or other conditions that require the restriction of painful motion or relief of pressure on the nerve roots. The procedure is performed without open decompression or fusion and includes image guidance when necessary.

5. When to use CPT code 22869

CPT code 22869 should be used when the provider performs the insertion of an interlaminar/interspinous process stabilization/distraction device in the lumbar spine without open decompression or fusion. This code is specific to a single level in the lumbar spine.

6. Documentation requirements

To support a claim for CPT 22869, the provider must document the following information:

• Patient’s diagnosis and the need for interlaminar/interspinous process stabilization/distraction
• Confirmation of the level of stenosis using image guidance, if performed
• Implant size and any bone or ligament removal
• Details of the procedure, including the type of device used and its placement
• Date of the procedure and any complications encountered
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 22869, ensure that the procedure is performed without open decompression or fusion and includes image guidance when necessary. Report +22870 for each additional level performed during the same session. If the procedure is performed with open decompression, report 22867 instead. It is important to check with the payer to confirm their coverage policies for this procedure.

8. Historical information

CPT 22869 was added to the Current Procedural Terminology system on January 1, 2017. There have been no updates to the code since its addition.

9. Examples

1. A patient with lumbar spinal stenosis undergoes the insertion of an interlaminar stabilization device at the L4-L5 level to restrict painful motion and relieve pressure on the nerve roots.
2. A provider performs the insertion of an interspinous distraction device at the L3-L4 level for a patient with degenerative disc disease, aiming to open up the neural foramina and alleviate symptoms.
3. A patient with lumbar spinal stenosis undergoes the insertion of an interlaminar stabilization device at the L5-S1 level to stabilize the spine and reduce painful motion.
4. A provider performs the insertion of an interspinous distraction device at the L2-L3 level for a patient with foraminal stenosis, aiming to relieve pressure on the nerve roots and improve symptoms.
5. A patient with lumbar spinal stenosis undergoes the insertion of an interlaminar stabilization device at the L1-L2 level to restrict painful motion and alleviate pressure on the nerve roots.