Please note that the intervertebral
device codes (22853, 22854, and 22859)
as well as the spinal instrumentation
codes are add-on codes and therefore
not subject to the -51 multiple procedure
Code 22853 was valued by the AMA RUC
at 4.88 work RVUs, which CMS revised to
4. 25 work RVUs. Code 22854 was valued
by the RUC at 5.50 work RVUs and this
value was accepted by CMS. Code 22859
was valued by the RUC at 6.00 work RVUs
which CMS revised to 5.50 work RVUs.
NASS strongly objected to the reduction
of these values as they had been fairly determined by the RUC survey process, but
CMS did not agree and finalized them
with no further consideration.
While it is unfortunate that these new
replacement codes are not valued at the
same level as the original code 22851
( 6.70 RVUs), this is the result of the AMA–
CPT–RUC–CMS process. NASS and each
of the specialty societies mentioned were
involved in the process through its entirety
and did everything possible to survey and
value these codes to accurately reflect
physician work. It is likelythat otherspinal
procedure codes will be subject to similar
scrutiny and change in the future. NASS,
its staff and volunteers will continue to
seek fair and appropriate reimbursement
for spine care wherever possible.
1. Foroohar, M. Clarifying Code 22851.
SpineLine. 2004; Nov-Dec. 33-34.
RD Blasier: Nothing to disclose
J Cheng: Other Office: AANS/CNS
D Lahey: Speaking and/or Teaching
Arrangements: NASS (B, Coding course,
paid directly to institution/employer).
Trips/Travel: NASS (B).
W Mitchell: Private Investments: South
Jersey Cyberknife ( 1 Share, 1%, no patient
referals to center). Speaking and/or
Teaching Arrangements: NASS (B, NASS
Coding Update courses honoraria).
Trips/Travel: NASS (B, NASS Coding
Update courses & NASS CPT Advisor).
K Swartz: Speaking and/or Teaching
Arrangements: AANS/CNS (A, Coding
course honorarium), NASS (A, Coding
NASS’ Coding and Payor Policy Review committees recently reviewed various payer
policies to ensure that policies are defined appropriately on this important code
change. Where appropriate, NASS shared comments and suggestions with payers
when their respective policies are not defined appropriately for these procedures.
n Payers should simply remove code 22851 from their lumbar fusion policies and
replace with 22853, 22854 and 22859 codes.
n The three new codes are NOT and should NOT be considered as investigational as:
n They still describe the same underlying procedure as that of the old CPT code
22851, which is insertion of an Interbody Biomechanical Device to the intervertebral disc space.
n The devices used for these new codes are the same noninvestigational devices
that were used when reporting the old CPT code 22851.
n The device is still placed in the space between two vertebrae in order to restore
lost disc height and stabilize the spine after the removal of disc or bone.
n Prior to the creation of these new codes, CPT code 22851 was routinely used to
code for all of the noninvestigational procedures now coded as listed below. The
only difference in the three new codes lies in the specificity of the application of
the device for a given patient population.
n Code 22853 is used when an intervertebral biomechanical device is placed in a
discectomy defect for the purposes of spinal fusion.
n Code 22854 is used when an intervertebral biomechanical device is placed in a
corpectomy defect for purposes of spinal fusion.
n Code 22859 is used when an intervertebral biomechanical device is placed in a
discectomy or corpectomy defect without fusion as in the case of a vertebral
resection for tumor or infection.
n These new Intervertebral Biomechanical Device codes should NOT be interpreted
as Interspinous Distraction/Fixation Device codes and/or listed in the Interspinous Distraction/Fixation Device coverage policies:
n Distinct from Intervertebral Biomechanical Devices, Interspinous Fixation
Devices rigidly attach to two adjacent vertebral spinous processes for
the purposes of stabilizing the motion segment and usually to augment
spinal fusion, whereas Interspinous. Distraction Devices are placed less
rigidly between two vertebral spinous processes in order to separate the
spinous processes to achieve indirect neurologic decompression. Thus the
Intervertebral Devices represented by the three new codes 22853, 22854 and
22859 are entirely different from the Interspinous Fixation Devices.
n Interspinous Distraction Devices are correctly identified by CPT codes 22867,
22868, 22869, 22870 and HCPC S code C1821.
n Intervertebral Devices are placed between the vertebral bodies (“interbody”)
in the front or anterior portion of the spine and may be placed from anterior,
lateral or posterior approaches to the vertebral bodies. Interspinous Devices
are placed between the spinous processes in the posterior-most part of the
spine and can be placed from a posterior approach only.
n Interspinous Devices are most correctly labeled as “Interspinous Process De-
vices,” so as not to confuse “Interspinous” with “Intervertebral.”
For more information, please contact NASS at firstname.lastname@example.org.