Each year the AMA (American Medical Association) publishes new, revised, and deleted codes to the CTP code set, including logic and rationale related to the updates. The CPT code set for 2022 includes several changes regarding spinal fusions- including revisions of guidelines, parenthetical notes, definitions and coding instructions. The key changes regarding spinal fusions will be highlighted in this blog.
Definition Updates
Definitions for anatomy associated with spinal fusion, laminectomy and other depression procedures have been added to the introductory guidelines to provide a better understanding of fusion procedures:
- Corpectomy: Identifies removal of a vertebral body during spinal surgery
- Facetectomy: The excision of the facet joint between two vertebral bodies. There are two facet joints at each vertebral segment.
- Foraminotomy: The excision of bone to widen the intervertebral foramen. The intervertebral foramen is bordered by the superior notch of the adjacent vertebra, the inferior notch of the vertebra, the facet joint, and the intervertebral disc.
- Hemilaminectomy: Removal of a portion of a vertebral lamina, usually performed for exploration of, access to, or decompression of the intraspinal contents.
- Lamina: Pertains to the vertebral arch, the flattened posterior portion of the vertebral arch extending between the pedicles and the midline, forming the dorsal wall of the vertebral foramen, and from the midline junction of which the spinous process extends.
- Laminectomy: Excision of a vertebral lamina, commonly used to denote removal of the posterior arch.
- Laminotomy: Excision of a portion of the vertebral lamina, resulting in enlargement of the intervertebral foramen for the purpose of relieving pressure on a spinal nerve root.
New illustrations can also be found in the introductory guidelines to provide coding professionals with visual representations of the terms/procedures performed. Be sure to review your CPT book for visual representations of the vertebral interspace (non-bony) and segment (bony), and areas of bone removed during foraminotomy, facetectomy, laminotomy, hemilaminectomy, laminectomy and corpectomy. Examples of TLIF, PLIF, and laminectomy techniques and procedures are also included.
Add-On Codes 63052 and 63053
Two new add-on codes (63052, 63053) have been established to report decompression of the neural elements with laminectomy performed in conjunction with interbody fusion of the lumbar vertebrae:
Along with the new add-on codes, several changes were made to the guidelines and instructions for interbody fusion procedures performed with laminectomy to clarify the following:
- New codes 63052 and 63053 may only be reported as add-on services when a decompressive laminectomy (with any other decompressive procedure, such as foraminotomy or facetectomy) is performed in addition to fusion procedures that use an interbody technique (ie, the fusion procedures identified by codes 22630-22634). Therefore, codes 63052 and 63053 may not be reported in conjunction with other fusion procedures
- Codes 63052 and 63053 should not be reported if the laminectomy is performed to prepare the interspace for fusion
- If decompressive laminectomy is performed by itself, then the existing laminectomy codes may be reported
Terminology Change: “Interspace”
Revisions have been made to address confusion regarding the term “level” and how it relates to an individual boney “segment” of the spine vs the “interspace.” In order to eliminate confusion as to what is specifically being addressed by the procedure code, the term “level” has been replaced with the term “segment” in many of the code descriptors, parenthetical notes and guidelines.
Please see below for a list of code descriptors that reflect this change in terminology:
|
CPT 2021 |
CPT 2022 |
| 22600 Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment | 22600 Arthrodesis, posterior or posterolateral technique, single interspace; cervical below C2 segment |
| 22610 Arthrodesis, posterior or posterolateral technique, single level; thoracic (with lateral transverse technique, when performed) | 22610 Arthrodesis, posterior or posterolateral technique, single interspace; thoracic (with lateral transverse technique, when performed) |
| 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) | 22612 Arthrodesis, posterior or posterolateral technique, single interspace; lumbar (with lateral transverse technique, when performed) |
| +22614 Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure) | +22614 Arthrodesis, posterior or posterolateral technique, single interspace; each additional interspace (List separately in addition to code for primary procedure) |
| 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar | 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace; lumbar |
| 22634 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; each additional interspace and segment (List separately in addition to code for primary procedure) | 22634 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace; each additional interspace (List separately in addition to code for primary procedure) |
Additional Information
Additional information regarding Spinal Fusion CPT Code Updates for FY 2022 can be found below:
- American Medical Association (AMA) CPT 2022 Professional Edition (includes rules and guidelines from the AMA’s CPT Editorial Panel)
- AHA Coding Clinic for HCPCS, First Quarter 2022 Page: 1-4 Surgery section CPT code update 2022: integumentary and musculoskeletal systems
- CPT Assistant, March 2022 Page: 3 “Spinal procedure updates”
CPT Assistant, November 1999 Page: 11 “Vertebral segment vs vertebral interspace”
