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Biomechanical device placement and anterior instrumentation
Recently, I discussed a couple of the more commonly encountered types of posterior instrumentation for spinal fusion procedures (posterior instrumentation). This blog focuses on types of anterior instrumentation for spinal fusion and the appropriate CPT® codes with discussion of commonly encountered National Correct Coding Initiative (NCCI) Procedure to Procedure edits (PTP).
When a surgeon performs arthrodesis of the anterior spinal column, an interbody biomechanical device may be placed in the intervertebral space after discectomy or in a vertebral body defect site after corpectomy. There are various biomechanical interbody devices, such as BAK cages, PEEK cages or mesh. The code descriptions for add-on codes 22853 and 22854 indicate that the insertion of the interbody device is performed in conjunction with interbody fusion. These codes are only reported when the objective of the interbody biomechanical device placement is spinal arthrodesis.
Add-on code 22853 is assigned for the interbody biomechanical device placement after a discectomy in one intervertebral disc space. This code can be assigned more than once based on the number of devices placed within the disc space between spinal segments.
 This illustration depicts interbody fusion cages in two intervertebral disc spaces. Add-on code 22853 is assigned twice, once for each cage placement in a separate intervertebral disc space. |
 Add-on code 22854 is assigned for the interbody biomechanical device placement in a corpectomy defect. In this illustration, corpectomies have been performed on two adjacent vertebral bodies. An anterior biomechanical device is placed into the corpectomy defect. Code 22854 is assigned one time. |
Add-on codes 22845-22847 are assigned for placement of anterior instrumentation as a stand-alone implant and not part of a variant of a biomechanical device anchoring.
It is important to note that the code descriptions for add-on codes 22853 and 22854 include the following verbiage, “Insertion of interbody biomechanical device(s) (e.g., synthetic cage, mesh) with integral anterior instrumentation for device anchoring (e.g., screws, flanges), when performed…”
American Medical Association (AMA) CPT Assistant*, March 2017 Page: 7-9, entitled “Spinal biomechanical device insertion,” explains that integral anterior instrumentation for device anchoring means that a screw or flange goes into the biomechanical interbody device to anchor the device in place. This differs from anterior instrumentation described by codes 22845-22847.
 This illustration depicts interbody biomechanical device placement with integral anterior instrumentation. In this illustration, the device is placed in the intervertebral space with screws interfacing the biomechanical device to anchor the device. |
 This illustration depicts a biomechanical device in a corpectomy defect (in blue). The vertebral body has been removed. The plate (in red) is affixed to the vertebral bone above and below the biomechanical device but does not interface with the biomechanical device itself. This is an example of anterior instrumentation that is not integral to the biomechanical device. |
An NCCI PTP edit is encountered when a code from 22845-22847 (anterior instrumentation) is assigned with code 22853 or 22854 (interbody biomechanical device).
A query is best practice if the documentation and/or manufacturer’s device information does not indicate whether the anterior instrumentation is an integral component of the interbody biomechanical device. Per 2023 NCCI Policy Manual for Medicare, Chapter 4.F.11, when anterior instrumentation is placed that is NOT an integral component of the interbody biomechanical device, the appropriate code from code range 22845-22847 is assigned with modifier -59 appended to bypass the NCCI PTP edit with code 22853 or 22854.
Rhonda Talley, CCS, CPC, is a senior nosology analyst with 3M Health Information Systems.
The information in the article is appropriate for use in facility and physician coding.
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Rhonda Talley
Senior nosology analyst
Rhonda, CCS, CPC, is a senior nosology analyst with the 3M Health Information Systems nosology team. During her professional career, Rhonda has held positions in outpatient physician coding and practice…
Thank you so much you made this so simple to understand and the pictures really helped in my understanding of the spinal procedure!