FIRST COAST SERVICE OPTIONS
LOCAL COVERAGE DETERMINATION
CODING GUIDELINES

Contractor’s Determination Number

22533

LCD Database ID Number

L32076

Contractor Name

First Coast Service Options, Inc.

Contractor Number

09102 – Florida
09202 – Puerto Rico
09302 – Virgin Islands

LCD Title

Lumbar Spinal Fusion for Instability and Degenerative Disc Conditions

 Coding Guidelines

Arthrodesis may be performed in the absence of other procedures and, therefore, when it is combined with another definitive procedure (e.g., osteotomy, fracture care, vertebral corpectomy or laminectomy), modifier 51 is appropriate.

CPT code 22534 is an add-on code to describe each additional vertebral segment on which the arthrodesis using lateral extracavitary approach is performed, after the first segment. This code should be used in conjunction with CPT code 22532 and 22533.

CPT codes 22840-22847 are billed in addition to the primary procedure code. These codes are used in conjunction with the following CPT codes included in this LCD: 22533, 22558, 22612, 22630, and 22800-22812, as well as other CPT codes not included in this LCD.

CPT code 22558 is for single interspace. For additional interspaces, use CPT code 22585.  When two surgeons work together as primary surgeons performing distinct part(s) of an anterior interbody arthrodesis, each surgeon should report his/her distinct operative work by appending modifier ‘-62’ to the procedure code. In this situation, modifier ‘-62’ may be appended to CPT code(s) 22548-22558 and, as appropriate, to the associated additional interspace add-on code 22585 as long as both surgeons continue to work together as primary surgeons.

 Comments

Definitions:

Anterolisthesis - A spinal disorder characterized by a dislocation of at least one vertebra relative to another. It occurs when an upper vertebral body, the main part of a vertebra, slips forward relative to the vertebra below. As it moves out of position, it can pinch the spinal nerves connected to the vertebrae involved in the displacement, and also potentially damage the spinal cord. This condition is graded by severity on the basis of how far forward a vertebra has slipped. Anterolisthesis is basically another term for spondylolisthesis.

Arthrodesis – The fusion of vertebrae over a joint space that occurs through a natural process or as a result of surgical procedure. In surgery, arthrodesis, or fusion between two vertebrae, can be achieved by placing bone graft and/or bone graft substitute to bridge the vertebrae so that new bone grows into the spaces.

Atlantoaxial: Pertaining to the first and second cervical vertebrae which meet at a joint called the atlantoaxial joint.

Discectomy - The partial or complete excision of an intervertebral disk. Also called discotomy.

Isthmic spondylolisthesis – Spondylolisthesis is a condition of spinal instability, in which one vertebra slips forward over the vertebra below.  Isthmic spondylolisthesis, the most common form of this condition, is caused by a bony defect (or fracture) in an area of the pars interarticularis.   

Laminectomy – A surgical procedure in which the posterior arch of a vertebra is removed. Laminectomy is done to relieve pressure on the spinal cord or on the nerve roots that emerge from the spinal canal. The procedure may be used to treat a slipped or herniated disk or to treat spinal stenosis.

Lateral extracavitary technique - A method in which the surgeon can safely approach lateral and anterior spine disease and perform posterior stabilization during the same procedure through the same incision.

Methimethacrylate – A colorless liquid used as a monomer in plastics   

 

Pars interarticularis - A region of the vertebra between the superior and inferior facet joints that is susceptible to trauma.

 

Spinal stenosis – An abnormal narrowing (stenosis) of the spinal column that may occur in any of the regions of the spine.

 

Sublaminar wiring – Accomplished by passing a wire or pair of wires around the lamina and rod; the ends are usually twisted together. Generally, a smooth rod is used and is attached to the spine at every laminar level.

 

Synthetic cages – Interbody cages used to obtain fusion and are either impactable or threaded. Usually the surgeon will fill the cage with a bone graph or a moprhogenic bone protein. 

Vertebral interspace - The non-bony compartment between two adjacent vertebral bodies, which contains the intervertebral disk, and includes the nucleus pulposus, annulus fibrosus, and two cartilaginous endplates.

Revision History

Date

Revision

10/16/2011

Original

 

Document formatted:  05/09/2011 (DA/et)