# 22853 cpt biomech devices



## mkndevh@msn.com (Jan 17, 2017)

Good Morning! Hoping to get some insight on new CPT 22853-22859 for spinal instrumentation biomechnical devices. I code for anesthesia only and deleted code 22851 had base units. New codes 22853-59 do not according to the 2017 Crosswalk for anesthesia. Could anyone tell me if the plating systems that support/anchor the cages/spacers are separately reportable or are they components of 22853? The following is a portion of op note where spacer is used with plating system. I don't normally code for spinal procedures, so I'm unfamiliar with what is all included in some of these codes. I believe 22851 included anchoring devices as components of the procedure. This was a two part surgery...this segment being the second. TIA!!!!

 OPERATION
 1. L4-5 retroperitoneal access for anterior lumbar interbody
 Fusion.
 2. L4-5 complete anterior diskectomy via retroperitoneal
 approach.
 3. L4-5 anterior arthrodesis with osteoAMP allograft, cellentra allograft.
 4. L4-5 placement of PEEK biomechanical spacer infused with allograft for fusion.
 5. L4-5 placement of anterior lumbar plating system with fixation screws x4 and
 locking plates x4.

 Once he confirmed the midline marking, as well as the lateral marking
 at L4-5, I performing an annulotomy with a 15 blade on a long handle. Straight and curved curettes, double
 action, were utilized to cleanse out disk. Curved curettes and straight
 curettes were utilized to cleanse out disk as well. I used TLIF spacers
 to indirectly elevate from 10 to 12 mm disk space. I additionally
 removed disk thoroughly, and then worked to get a far lateral recess
 toward the left side and right side, until I was able to withdraw a very large disk
 herniation of the left lateral recess.
 **
I then trialed up to a PEEK spacer, which was 12 mm tall and I packed this with allograft, and this was placed into
 The disc space at L4-5. I placed fixation screws on a plate, which was a Lanx plate with 25 mm x
 5.0 inferior and 30 mm x 5.0 cephalad with a locking plate at L4-5. [/B] 


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## dwaldman (Jan 18, 2017)

I am unable to find Lanx plate and screws on an internet search without the name of the plate. You might want to contact the surgeons office and see if this is a stand alone plate that is considered to provide independent stabilization without being attached to the peek spacer/cage or if this solely for preventing the cage from "backing out" or actually attached to the cage/spacer. It is hard to tell from the note if they will report CPT 22845 separately, so you might have to  contact the surgeons office 

AMA CPT Changes 2017 states the codes are used for procedure performed to an intervertebral disc space or vertebral body corpectomy(ies) defect with anterior instrumentation for device anchoring when performed. 

I believe that anterior instrumentation that is a completely separate construct from the intervertebral device can separately be reported when the anterior instrumentation is used for stabilization and could provide benefit separate from the intervertebral device.

Below is from May 2016 CPT Assistant. 

Surgery: Musculoskeletal System 
Question: Does anterior spinal instrumentation have to be performed for both compression and stabilization of the surgical site in order to be considered for coding?

Answer: No, anterior instrumentation is placed to sustain loads; therefore, it may be used in varying ways including for indications such as deformity correction or neutralization. To separately report code 22845, Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure), the instrumentation must be able to provide support as a stand-alone implant, and must not be just a part of a variant of a biomechanical spacer, such as “low proﬁle” or “integrated” intervertebral devices that have an attached plate/buttress screws or a device that cannot provide independent stabilization without being attached to the intervertebral device as described by code 22851, Application of intervertebral biomechanical device(s) (eg, synthetic cage(s), methylmethacrylate vertebral defect or interspace (List separately in addition to code for primary procedure).

Question: Are all buttress plates reportable under anterior spinal instrumentation CPT codes 22845-22847?

Answer: No, an example would be the placement of a screw or small plate and screw to retain a graft or cage. Single screw and washer systems that are placed to prevent graft or cage kick-out cannot withstand a biomechanical load, if they are placed as a stand-alone device.


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## Venkatakrishnan (Jan 19, 2017)

Hi,

Please confirm my understanding on Instrumentation scenario. 

When some Plate(s) and / or Screws are used to support the vertebral segments and providing stability to the segments, it is acceptable to use CPT range 22840-22848. 

But during procedure like Cage fixation (CPT range 22853 to 22859) some small screws may be used for the purpose of holding or supporting the cage to the vertebrae. They are helping the cages to get fixed with vertebrae. They do not directly provide stability to the vertebral segments.

What I have mentioned is just my understanding. It would be grateful if someone guides me to reach the correct concept.

Thanks,
Vernon Kreiss


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## mkndevh@msn.com (Apr 5, 2017)

Thank you! That is what I found as well!


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