# 22220 & 22226 Cervical Osteotomy



## coderguy1939 (Oct 14, 2008)

Surgeon performed a cervical osteotomy at C5 and C6.  The descripton of 22220 says osteotomy of spine, single vertebral segment.  Would 22220 cover both C5 & C 6 or would I need to use 22226 as well?  Thanks for your input.


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## mbort (Oct 14, 2008)

I'm not a spine specialist..but since 22220 does state "each segment" rather than "interspace" I would add the 22226.  

my two cents 
Mary


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## Anna Weaver (Oct 14, 2008)

*osteotomy*

I will add my two cents with Mary's. I agree add the 22226 as well.


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## BCrandall (Oct 14, 2008)

I'd like to see the op note, if possible, before passing judgement. We do a lot of spine surgeries and that code has very rarely been used...


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## coderguy1939 (Oct 14, 2008)

Here is the scrubbed op report:

Cervical spine was prepped and draped in the usual sterile fashion and about 3-cm incision was made approximately two and half fingerbreadths proximal to the sternal notch with Langer lines.  Once the skin was incised sharply all the way through the platysmal layer, the fascia of the sternocleidomastoid muscle was incised and elevated proximally and distally and a finger was bluntly inserted on the medial border of the sternocleidomastoid muscle to palpatate the anterior cervical spine medially and the carotid sheath laterally.  

There was noted to be extremely large osteophytes extending from the C5-C6 disc space as determined on the preoperative x-rays.  The longus colli of either side of the osteophyte was elevated and self-retaining retractor was then placed.  The needle was placed inside the C5-C6 disc space.  The needle localization by fluoroscopy was performed.  This confirmed the operative level.  Next an osteotomy was performed of the C% and C6 vertebral bodies as there was a bridging bone across the disc space restricting access to the C5-C6 disc.  Once the osteotomes were performed, the the disc material was cleaned with angled curettes and pituitary rongeurs all the way out to each uncovertebral joint.  The microscope was brought in and a high-speed bur was used to perform a partial vertebrectomy removing the distal portion of the C5 and proximal portion of the C6 vertebral body.  Extensive vertebral body resection was performed as there were large posterior osteophytes extending cranially and caudally.  Once the vertebrectomies were performed, an angled curette was inserted behind the vertebral bodies of C5 and C6 to elevate the posterior longitudinal ligament.  This was excised all the way across the disc space.  This revealed the dura.  Once the posterior longitudinal ligament was cut, the angled curette could be inserted behind the vertebral bodies of C5 and C6 to palpate the decompression.  It was noted the central decompression was adequate and these foramina were also adequately decompressed.  Bleeding was stopped with Surgiflo.  The a trial spacer was impacted into the disc space and 8mm machined allograft bone dowel was filled in demineralized bone matrix as well as bone harvested from the corpectomy site.  It was carefully impacted into the disc space feeding it just deep to the anterior surface of the vertebral bodies of C5 and C6 and a Synthes CSLP plate was placed over the construct and each of the four holes were drilled, placed with a 14mm screw and the locking screws per the manufacturer's direction.  Another lateral fluoroscopic view was taken from the position of the hardware which was excellent.  The wounds were copiously irrigated..."  etc.
I am looking at using the following codes:
63081, 22554, 22845 and was considering 22220 and 22226.  Per AAOS guidelines using 22220 includes 63081.

Any help with this would be appreciated.


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## BCrandall (Oct 15, 2008)

I would use the 63081, 22554, 22851 and 20931. This is a corpectomy for sure!

22220 is used mostly for re-aligning the spine for Spondylolisthesis (love that word!), Kyphosis, Scoliosis and the like.

Hope that helps.

-Bruce


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## RebeccaWoodward* (Oct 15, 2008)

Bruce, 

Out of curosity...you didn't mention 22845.  What's your thoughts about this?

"It was carefully impacted into the disc space feeding it just deep to the anterior surface of the vertebral bodies of C5 and C6 and a Synthes CSLP plate"

It's great to have a spine CPC so close to home!


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## BCrandall (Oct 15, 2008)

rebeccawoodward said:


> Bruce,
> 
> Out of curosity...you didn't mention 22845.  What's your thoughts about this?
> 
> ...



Oh yeah! Thanks Rebecca. Add that to the list...sorry need more coffee.


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## coderguy1939 (Oct 15, 2008)

Thanks for all of your help, Bruce.  Really appreciate it.
David


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