Basics of CPT code CPT code 22853, 22854 and 22859

A procedure is performed to decompress the spinal cord and nerves and restore intervertebral disc space and anatomic alignment with insertion of an intervertebral biomechanical device. Surgical immobilization of the spine by fusing adjacent vertebrae (arthrodesis) and/or removing all or part of a vertebral body (corpectomy) may be done for degenerative disc disease, spinal stenosis, or bone spurs (osteophytes).

The intervertebral biomechanical device is usually a cylindrical or square-shaped synthetic cage that can be packed with autogenous bone material to promote arthrodesis. For cervical placement, a horizontal incision is made in the side of the neck. The platysma muscle is transected, the plane between the sternocleidomastoid muscle and strap muscles is entered, and the space between the trachea/esophagus and the carotid sheath is accessed.

The fascia is dissected away from the disc space. For lumbar placement, an incision is made in the left side of the abdomen and the muscles retracted. The peritoneum is kept intact and retracted to the side as are vascular structures such as the aorta and vena cava. For both approaches, all or part of the intervertebral disc may be removed in a separately reported procedure.

The biomechanical device is placed into the intervertebral disc space (CPT code 22853) or vertebral body defect (CPT code 22854) in conjunction with interbody arthrodesis. Bone graft material may be inserted into the device, with integral anterior fixation of the device, if performed, accomplished using screws/flanges. CPT code 22859 is reported when an intervertebral device, such as a synthetic cage, mesh, or methylmethacrylate, is inserted into the intervertebral disc space or vertebral body defect to maintain foraminal height or spinal cord/nerve decompression without arthrodesis, or fusing of adjacent vertebrae..

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Description of CPT code 22853, 22854 and 22859

In this exam, the physician replaces an intervertebral disc resected due to destruction by disease, trauma, or other processes. Once the vertebral disc has been removed by a separately identifiable procedure, a hole is cored out of the vertebral bodies above and below the removed vertebrae to secure a biomechanical device (synthetic cage or mesh) into the resulting intervertebral disc space.

The physician selects the biomechanical device best suited to the location and type of deformity being corrected. Screws, wires, or plates may be used to secure the device. Muscles are allowed to fall back into place and the wound is closed over a drain with layered sutures.

The code description is very specific for each CPT code. The device used in each procedure vary and also the location for insertion of the device.

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)

22854 – Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to vertebral corpectomy(ies) (vertebral body resection, partial or complete) defect, in conjunction with interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)

22859 – Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)

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CPT code 22853 and 22854 are to be used when a insertion of device is performed with fusion. Only when a corpectomy is performed along with fusion we have to use code 22854, and for without corpectomy and with fusion we have to report cpt code 22853. For procedure with insertion of a device without fusion, should be reported with CPT code 22859.

Do not append modifier 62 (Two surgeons) to +22853, +22854 and 22859.

Report +22853, +22854 and 22859 in addition to the definitive procedure(s) since all these are an add-on codes.