# 22845 ant. instrument w/ 22853 Interbody device w/ integral ant instrument



## wallstk (Jan 27, 2017)

I have seen a couple posts regarding 22845 anterior instrumentation coding with new 2017 code 22853 interbody device with integral instrumentation but am still confused regarding when the plate can be coded separately.

Upon reading previous posts, if using combo interbody/plate such as Prevail Cage then the instrument would not coded separately. 

How will coder know if the interbody/plate is a combo type device or independent stabilization and not integral?


OP Note
1. Anterior cervical decompression C6-7
2. Arthrodesis PEEK cage filled with local autograft and DBX
3. Intrumented fixation with plate and 4 screws

Simplified Description of Cage and Plate:
6mm Bengal cage placed after filling with pt bone and DBX. We flattened anterior vert. body in prep for plate. We tried differ size plates. The 14 mm Skyline plate was good fit and placed four 14 mm self drilling screws.

Thank you for guidance and clarification.


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## holly.hall99@yahoo.com (Feb 2, 2017)

*22853 and 22845*

This sounds like both codes 22853 and 22845 would be appropriate. Sometimes a provider uses a buttress plate to keep cage in place.  This is not the "plate" fixation in 22845.  The provider should make clear which he is using in his documentation, helpful to know plate types and names to identify such in documentation.


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## Mizuru19 (Feb 9, 2017)

*Please claify when 22853 should be billed alone or WITH 22845?*

Hello, I am still very confused because based on the wording of code 22853 "Insertion of interbody biomechanical devices (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace." Whenever our physicians does the ACDF for C5-6, for example, they always use the interbody PEEK cage with anterior instrumentation with screws at C5-6, plus an allograft of morselized bone for fusion.  I was under the impression that in these cases the 22845 will be inclusive of 22853.  Meaning I would bill:  22551, 22853, 20930.  

Should this be billed 22551, 22853, 22845, 20930 instead?

Would someone please clarify under which circumstances would 22853 be billed alone or when 22853 be billed with 22845?

Thank you in advance!


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## mkmgt001 (Nov 22, 2017)

*Cpt 22853 & 22845*

*CPT Assistant March 2017 *states the following:

Code 22853 includes the integral anterior instrumentation for device anchoring that is part of some devices, such as a screw or flange that goes through the biomechanical device to anchor the cage into the disc space. The device anchoring is not the same as anterior instrumentation, which is reported separately when performed. Anterior instrumentation of the spine is denoted by the ability of the instrumentation to stabilize the spinal segment(s) as a standalone device without the cage present, such as with anterior cervical plating or anterior rod system fixation. _If the plate is “integrated”, and only used with the cage to keep it in the disc space and not able to be used as a standalone device for biomechanical support such as in a fracture or deformity, then you would not report 22845 and just 22853 or 22854 only. _In addition, use of a posterior instrumentation to stabilize the spinal segment(s), such as posterior lumbar pedicle screw fixation, is reported separately. 

Based on this information, it sounds like CPT 22853 ALONE should be reported for the scenario posted by "wallstk" - not 22853 AND 22845, as the Skyline plate is the only thing holding the cage in place. Would that be everyone's interpretation as well?

Thanks,
Mary


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## sarab86 (Dec 22, 2017)

I am been billing these as 22845-59, and 22853. My providers do on occasion use the Prevail cage and they have to document "Prevail" for me to know. 

Just recently UHC Medicare has started denying this code combination. As in the last 3 months. 

You need to have a sit down with your providers or one you have a good open communication with and have them explain why and how they use the plate on ACDF cases. You may find your provider enjoys the teaching aspect and you can get a very clear picture of the process. They need to be able to say that with devise is used for independent stabilization. 

I have also been going to the manufacturers website and printing the product catalog and sending it with my appeals t should illustrated proof that these are completely separate devises used for different reasons. I am about to start using a different DX for the plate and the cage and see if that helps explain medical necessity. 

NOTE: I was told by AANS that this code combo was a 2017 CCI Edit but it is actually a 2018 CCI Edit. Be prepared for Medicare and a lot or carriers to start requesting notes on all your ACDF cases in 2018 before they payout anything.


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## mkmgt001 (Jan 10, 2018)

Thank you for your response Sara.  I just came upon an AAPC article dated 5/1/17 that I found helpful too. The article states the following:

_The intervertebral device with an integrated anterior plate, also called a “low profile” or “stand-alone” device, is accurately reported using only +22853. It is incorrect to separately report +22845 if an integrated plate was used to secure the device into the interspace.

How will you know if the device should be reported using +22853 only, or using both +22853 and +22845? The spine surgeon should document in the operative report the specific trade name of the spinal implant so the correct code(s) are reported. You can also look up the device on the internet to see what it looks like and determine if it qualifies for one or two codes._

https://www.aapc.com/blog/38422-stay-current-with-spine-procedural-coding/


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