CPT Coding for Spine Part Four Flashcards

Updated Course Content

• Pages with new, updated, or refreshed content are marked with an asterisk.
• Use the table of contents to find updated pages.

CPT Coding for Spine Part 4: Osteotomy and Spinal Deformity Correction

• Focuses on procedures to correct spinal deformities like scoliosis and kyphosis.
• Consists of three lessons and a scored assessment.
• Focuses specifically on osteotomy and deformity correction; it's important to note that four components/procedures have to be considered in every spine surgery.

Spinal Surgeries and CPT Codes

• Require reporting of multiple CPT codes to accurately reflect the combination of procedures.
• Many codes exist to report various interventions for a specific surgical session and may be reported separately when performed.

Lesson 1: Spinal Osteotomy Guidelines

• Objective: Summarize CPT guidelines, describe intended use, and understand reportable combinations.
• Instrumentation codes are add-on codes and require a primary procedure. CPT specifies appropriate primary procedures.
• Instrumentation provides support and stability to the spinal column after a primary procedure like fusion, decompression, or fracture treatment.
• Hardware acts as an internal brace. Grafting material causes fusion.
• Spinal osteotomy procedures involve cutting and removing portions of vertebral segments to realign the spine for spinal deformity correction.
• Deformities may be congenital, developmental, or degenerative.
• Some procedures can be reported separately, while others cannot.

Procedures Reportable Together

• Laminectomy
• Facetectomy
• Foramenectomy
• Discectomy

Procedures Reportable Separately

• Arthrodesis
• Grafting
• Instrumentation

Lesson 2: Osteotomy CPT Codes

• Objectives: Describe osteotomy procedures, identify spinal anatomy, and recognize related terms.
• First osteotomy code family: CPT codes 22206 through add-on code 22208.
  • Used for procedures on the thoracic or lumbar spine via a posterior or posterolateral approach.
  • Known as pedicle subtraction osteotomies.
• Vertebral Anatomy:
  • Vertebral body: anterior portion of the spinal column.
  • Pedicle: part of the posterior spinal column.
• Three Column Osteotomy: Reported with codes 22206-22208.
  • Definition: After cuts and bone removal, the vertebra is positioned into correct alignment.
• Smith Peterson Osteotomy (Ponte Osteotomy):
  • Described as opening wedge osteotomy.
  • Removes bone from posterior elements to create a gap for spinal realignment.
  • Removes less bone than three column osteotomy.
• Anterior Approach Osteotomy:
  • Code family: CPT codes 22210 to 22216.
  • Osteotomy of a single vertebral segment via an anterior approach.
  • Wedge of bone removed from the middle of the vertebral body.
  • Spine is extended to correct deformity.

Lesson 3: Arthrodesis for Spinal Deformity Corrections

• Objectives: Apply arthrodesis codes, identify additional reportable services, and understand intended use.
• Arthrodesis for spinal deformity correction is not differentiated by spinal region, but by approach and number of segments fused.
• No age limits for these codes.
• Spinal deformity may be congenital (e.g., scoliosis) or acquired.
• These codes are not reported for fusion for spinal deformity due to a fracture or previous arthrodesis.