Wiki 22853 inserted bilaterally

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genies5035

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Some of my surgeons are inserting PEEK cages bilaterally and wanting to report 2 units. While the MUE for this code is 4 units, it is my understanding that only one cage can be reported per interspace. Does anyone have AANS or CMS documentation I can forward to my surgeons supporting this? I feel that the CPT description of this code is a bit vague in this instance. It does say each interspace, but I don't feel that it's made clear. My AANS Spine Focused Coding book doesn't say anything on this particular subject.

+22853 Insertion of interbody biomechanical device(s) (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 (List separately in addition to code for primary procedure)
 
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I know CPT descriptions can be somewhat unclear in many cases, but this does state to report it for 'each interspace', not per cage/device. It is billed once per each interspace, whether 1 or 2 cages were inserted at that level. I don't have access to AANS, but Medtronic also supports this stating 'assigned once for each interspace (not per device)'. https://www.medtronic.com/content/d...t-services/reimbursement/cpt-coding-guide.pdf
 
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"each interspace" is your answer, as well as the info from Susan above. So, if it was applied to three interspaces, it would be three units. Have any claims gone out incorrectly with more units of 22853 than were correct? If so, they are probably denied and you can show them the $/denials. If there are only x # of arthrodesis levels billed for, but more 22853, the claim won't add up and will most likely deny or you'll get a records request and recoup.

CMS NCCI: Plural reference. https://www.cms.gov/files/document/medicare-ncci-policy-manual-2024-chapter-4.pdf
11. CPT codes 22853 and 22854 describe insertion of interbody biomechanical device(s) into intervertebral disc space(s). Integral anterior instrumentation to anchor the device to the intervertebral disc space when performed is not separately reportable. It is a misuse of anterior instrumentation CPT codes (e.g., 22845-22847) to report this integral anterior instrumentation. However, additional anterior instrumentation (i.e., plate, rod) unrelated to anchoring the device may be reported separately appending an NCCI-associated modifier such as modifier 59 or XU.

See KZA info (old but same concept because instead of cages(s) it is devices(s): CPT code 22853 is reported per interspace to describe intervertebral biomechanical devices, including PEEK cages. The term is both single or plural, “cage(s)”, because sometimes there are two devices placed at a single spinal level.

This isn't really "official" & a little old but same idea: https://www.managedresourcesinc.com/wp-content/uploads/2019/08/Spinal-Coding-Handout.pdf
• The interspace where the implants were placed...not the number of implants placed
 
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