2025 CPT code 22846
(Active) Effective Date: N/A Revision Date: N/A Surgery - Spinal Instrumentation Procedures on the Spine (Vertebral Column) Surgical Procedures on the Musculoskeletal System Feed
Anterior spinal instrumentation involving four to seven vertebral segments; reported in addition to the primary procedure.
Modifiers 22 (increased procedural services), 59 (distinct procedural service), 76 (repeat procedure), and 78 (unplanned return to OR) may be applicable under specific circumstances.Modifier 62 is not allowed.Check payer-specific guidelines for modifier acceptance.
Medical necessity is established by documentation of a spinal deformity (e.g., scoliosis, kyphosis, spondylolisthesis) or instability requiring surgical stabilization.Imaging studies should support the diagnosis and demonstrate the need for instrumentation.
The surgeon's responsibilities include identifying the target vertebral segments, preparing passageways for fixation screws, placing screws, securing plates/rods/cables, possibly using methyl methacrylate cement, and contouring rods for optimal spinal alignment.They must also carefully avoid injury to the spinal cord and nerves.
- Surgical Procedures on the Musculoskeletal System
- Spinal Instrumentation Procedures on the Spine (Vertebral Column)
In simple words: This code describes a surgery where the doctor puts metal screws, rods, or plates onto the front of the spine to hold the bones in place and correct a spinal problem. This is only part of a bigger surgery and will be billed separately in addition to the main surgery.
This CPT code, 22846, represents the insertion of an anterior spinal fixation device spanning four to seven vertebral segments.It is an add-on code and must be reported with a primary procedure code (e.g., spinal fusion, arthrodesis). The procedure involves placing screws, rods, plates, or cables to stabilize the spine, typically to correct spinal deformities or provide support after other spinal surgeries.The surgeon carefully avoids damaging the spinal cord or nerves during placement. Methyl methacrylate cement might be used to enhance fixation.This code does not include the primary procedure itself, only the instrumentation.
Example 1: A patient with severe scoliosis undergoes posterior spinal fusion.Code 22846 is used to report the insertion of anterior instrumentation across 5 vertebral segments to supplement the posterior fusion., A patient sustains a burst fracture requiring anterior corpectomy and fusion.22846 is used to bill for the insertion of anterior instrumentation across 6 vertebral segments to stabilize the reconstruction., A patient with severe spinal stenosis undergoes anterior discectomy and fusion.Code 22846 reports the placement of an anterior plate across 4 vertebral segments for additional stability.
Detailed operative report specifying the approach (anterior), number of vertebral segments instrumented (4-7), type of instrumentation used (screws, rods, plates, cables), and any supplementary materials (cement).Preoperative and postoperative imaging (X-rays, CT scans) to demonstrate the need for and successful placement of the instrumentation.
** Careful documentation is essential for accurate reimbursement. The number of vertebral segments instrumented must be accurately recorded.Consult with your payer to clarify any specific coding or reimbursement guidelines.
- Revenue Code: P3D (MAJOR PROCEDURE, ORTHOPEDIC - OTHER)
- RVU: Consult the Medicare Physician Fee Schedule (MPFS) and Local Coverage Determinations (LCDs) for current RVU values.These values are subject to change.
- Global Days: The global period is determined by the primary procedure with which this code is bundled.This add-on code does not have its own inherent global period.
- Payment Status: Active
- Modifier TC rule: Not applicable. This code does not involve a technical component.
- Fee Schedule: Consult the appropriate fee schedules for the relevant years. Reimbursement rates vary by payer and region.
- Specialties:Orthopedic Surgery, Neurosurgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center, Hospital Outpatient