Coding
Anterior Instrumentation: Are You Nailing the Nuances of CPT 22845?
Ira Goldstein, MD
New Jersey Brain and Spine Hackensack, NJ
Karl Janich, MD
Indiana University Health Physicians Lafayette, IN
Donna Lahey, RNFA
Spine Institute of Arizona Scottsdale, AZ
Current Procedural Terminology (CPT) code 22845 for anterior instrumentation is a staple in the spine surgery coding world. Yet, with the evolution of interbody/Intervertebral fusion devices, its proper application has become a source of confusion and a focus of payer scrutiny. This article aims to clarify the correct usage of CPT 22845, with a special focus on its interaction with interbody cages that feature intrinsic fixation, and to highlight other common coding pitfalls.
CPT 22845: The Official Definition
Let's begin with the basics. The American Medical Association (AMA) CPT codebook defines 22845 as:
+22845: Anterior instrumentation; 2 to 3 vertebral segments (list separately in addition to code for primary procedure)
This code describes the placement of an implant, such as a plate, on the anterior column of the spine to provide immediate, rigid stabilization. This procedure is typically performed in addition to an arthrodesis. As an add-on code, it must be reported with an appropriate primary procedure and should never be billed as a standalone service.
The Core Conundrum: Interbody/Intervertebral Biomechanical Devices (Cages) with Intrinsic Anterior Instrumentation
The primary challenge in coding for anterior instrumentation today lies in its relationship to modern interbody/intervertebral fusion devices. Many of these devices, often described as “standalone” or “low-profile,” are reported with codes +22853 and +22854.
The key phrase in the descriptor for +22853/+22854 is “with integral anterior instrumentation for device anchoring.” This means that screws, flanges, or other fixation mechanisms that are built into the cage to anchor it within the disc space are considered part of the work of +22853/+22854 and are not separately reportable.