2025 CPT code 22830
(Active) Effective Date: N/A Revision Date: N/A Surgery - Spine Musculoskeletal System Feed
Exploration of a previous spinal fusion to assess the fusion's status and spinal stability.
Modifiers 51 and 59 may be applicable depending on the circumstances of the procedure.
Medical necessity is established when the patient presents with persistent pain or neurological symptoms following a previous spinal fusion, and there is a clinical indication to assess the fusion's integrity and stability for potential revision or other intervention.
The surgeon's responsibilities include surgical exploration of the previous fusion site, assessment of fusion integrity and stability, potential adjustment or replacement of spinal instrumentation, irrigation, hemostasis, and wound closure.
In simple words: The doctor checks on a previous spinal fusion surgery to see if the bones have healed together properly and if the spine is stable.This might involve adjusting or replacing some metal parts used in the previous surgery.
Exploration of spinal fusion (22830) involves a surgical procedure to assess a prior spinal fusion (arthrodesis).The surgeon makes an incision, dissects to the fused vertebrae, confirms fusion integrity, and evaluates spinal stability.Instrumentation adjustment or replacement may be performed. The surgical site is irrigated, hemostasis is achieved, instruments are removed, and the incision is closed.This procedure is distinct from a major spinal fusion, which involves significant bone graft placement and/or instrumentation.Appreciable vessel exploration or neuroplasty should be billed separately.If instrumentation removal occurs, it is considered part of the exploration only if it's solely for assessment; if removal is for reasons other than assessment (e.g., damage, rejection, adjustment as part of a broader reconstruction), it should be billed separately.
Example 1: A patient presents with persistent pain after a previous spinal fusion. An exploration is performed to evaluate the fusion's stability and assess for any complications, such as hardware loosening or breakage. No further surgical intervention is required beyond exploration. , A patient has experienced pain at the site of a previous spinal fusion.The surgeon explores the fusion, discovers a small area of non-union, and performs a revision arthrodesis with additional bone graft augmentation.The exploration code is reported separately.This would require modifier 51 for the multiple procedures., The patient undergoes an exploration of spinal fusion with removal of broken pedicle screws. The removal is reported separately because the screws broke and caused significant pain, so the instrumentation removal is separate from the exploratory aspect of the procedure.
** Always check payer-specific policies and guidelines before billing this procedure. Reimbursement may be denied if the documentation does not fully support the medical necessity of the exploration. Careful attention to documentation and accurate coding is essential to ensure proper reimbursement.
- Revenue Code: This will vary by payer and facility.
- RVU: RVUs vary by geographic location and payer. Consult a fee schedule for current values.
- Global Days: The global period is determined by the payer. Typically, there is no global period for this exploration procedure alone.
- Payment Status: Active, but reimbursement is subject to payer-specific policies and may require modifier 59 if performed in a different anatomic area from other spinal procedures.
- Modifier TC rule: Not applicable.
- Fee Schedule: Fee schedules vary by payer and geographic location; consult relevant fee schedules for historical data.
- Specialties:Orthopedic Surgery, Neurosurgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center