Basics of CPT codes 22867, 22868, 22869 and 22870

To increase the space within the neural foramen and release nerve pressure to decrease pain, interspinous/interlaminar process stabilization/distraction device is placed. Interspinous device is placed within the vertebral spinous processes. Interlaminar devices are placed between adjoining lamina and spinous process.  CPT code 22867, 22868, 22869 and 22870 are used for these procedures. Earlier old codes 0171T & +0172T were used for Coding these procedures. It is very important to be remain update with codes, to improve your coding skills in surgery facility. 

In this exam, the devices are inserted through small incision in the spinous process. For procedure code 22867, open decompression or laminectomy is also performed. During this procedure, the lamina of the affected area is removed to release pressure on the spinal cord and nerves. CPT code 22867 is first coded for the insertion of these devices in addition to open decompression of a lumbar vertebra without fusion. Use add-on code 22868 when the same exam is performed on the second vertebral level. All the imaging guidance are included in these procedure codes.

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Description of CPT codes 22867, 22868, 22869 and 22870

Insertion of interspinous/interlaminar process stabilization/distraction devices is performed to increase the space within the neural foramen and release nerve pressure thereby decreasing pain. Interspinous devices are inserted within the vertebral spinous processes and interlaminar devices are inserted between adjoining lamina and spinous processes to create effective stabilization with wings enclosing the inferior and superior spinous processes. The device opens the space while maintaining the spine’s ability to bend in that area. This procedure secures the supraspinous ligament, which helps keep the device intact. Some devices may necessitate extraction of the interspinous ligament with enclosure of the upper and lower spinous processes. This may be done after decompression surgery or as a substitute for decompression surgery. The devices are inserted via a small incision (4 cm to 8 cm) among the spinous processes with the patient mildly anesthetized or utilizing a local anesthesia. In 22867, an open decompression (laminectomy) is also performed. During this procedure, the lamina of the affected area is removed to release pressure on the spinal cord and nerves. The foramen may be expanded by an anterior approach and by creating an opening within the disc space at the front of the spine or between two pedicle screws inserted posteriorly. At this point, the interspinous/interlaminar devices are inserted. CPT code 22867 is reported for insertion of these devices in addition to open decompression of a lumbar vertebra, without fusion. CPT code 22868 is reported when the same procedure is performed at a second vertebral level. Imaging guidance, when performed, is included.

CPT code  22869 is reported for insertion of these devices at a single lumbar vertebral level, without fusion or open decompression. CPT code 22870 is reported when the same procedure is performed at a second vertebral level. Imaging guidance, when performed, is included.

22867 – Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level

+22868 – ; second level (List separately in addition to code for primary procedure)

The insertion of interlaminar or interspinous process devices when performed without open decompression, then we have to use CPT code 22869 and 22870. For initial Lumbar vertebra, use CPT code 22869 and, for each additional vertebra use add-on code 22870. Imaging guidance should not be reported separately, they are included in the procedure codes.

22869 – Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; single level

22870 –; second level (List separately in addition to code for primary procedure)