# Cervical Artificial Disc



## IRISHCODER (Oct 15, 2008)

There is no CPT code for a cervical total disc arthroplasty yet, so do you only use the technology code 0090T with a corpectomy code (63081)?  He did do a corpectomy of C6-7, and a diskectomy.  Can you add 22845 since the implant is held in place with screws and a plate?  Someone suggested 22851 , but I just don't feel that is correct.  I was also advised to use arthodesis code 22554, as he did a preparatory discectomy.  Anyone code one of these?  This is my first. Thanks!


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## RebeccaWoodward* (Oct 15, 2008)

22851 are for bio-mechanical devices such as the various PEEK spacers, threaded fusion devices, etc.  22845 are typically referenced as a plate system.  0090T would be linked to the cervical disc arthroplasty.  As for the rest of your codes, it would be easier if you posted the op note.


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## IRISHCODER (Oct 15, 2008)

....We were at the C6-7 level.  The soft tissues were then stripped off the C6 and C7 vertebral levels and the disk was isolated.  Caspar distraction pins were placed, and then the disk itself underwent distraction using the Caspar pins.  A complete diskectomy then took place including utilization of a variety of instruments including Bovie, a variety of curettte, pituitaries, and Kerrison ronguers.  The decompression took place in the central, bilateral recess and bilateral neural foraminal areas, and a massive disk herniation was identified and removed from the spinal canal.  This required removal of the posterior longitudinal ligament to adequately decompress the canal.  Excellent neurologic freedom was deemed absolutely complete and good parallel endplates were identified.  As much cortical bone was left on the endplates as possible.
Once this was complete and the midline further marked, the disk was sized.  The disk required that it be placed as far posterior as possible, and this was imaged under C-arm guidance under magnification very carefully to place the disk at the right size.  A 6 X 14mm device was deemed the best size.  The disk was then passed off the table, attached to the insertion device and then tamped into place into the C6-7 level.  It was placed along the midline, and excellent position was identified under C-arm guidance.  It was placed as posteriorly as possible.  Once this was complete, 2 superior and 2 inferior screw holes were drilled and screws inserted.  The screw heads underwent locking with the cover plate on C6 and C7.  Final images in the AP, lateral and magnified planes revealed excellent placement of the disk as far posterior as possible.


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## Claudia Yoakum-Watson (Oct 15, 2008)

Just as an FYI - Effective in January, there will be a Category l code for cervical arthoplasties.


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