2025 CPT code 22858
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Surgical Procedures on the Musculoskeletal System Surgery Feed
Total disc arthroplasty (artificial disc), anterior approach, including discectomy with endplate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); second level, cervical.
Modifier 51 (multiple procedures) may be appended if other procedures are performed during the same session.
Medical necessity is established by the presence of clinically significant cervical disc disease causing radiculopathy, myelopathy, or intractable neck pain unresponsive to conservative management.The procedure must be deemed the most appropriate treatment based on the patient's specific clinical presentation and condition.
The clinical responsibility involves the surgeon performing a total disc arthroplasty via an anterior approach. This includes the incision, dissection, protection of vital structures, disc removal, osteophytectomy, decompression, and implantation of the artificial disc. Post-operative care is also the responsibility of the surgeon.
In simple words: This procedure replaces a damaged disc in your neck with an artificial one.The doctor makes an incision in the front of your neck, removes the old disc and any bone spurs causing pressure on nerves, and then puts in a new, artificial disc. This is done at a second level in the neck, after a similar procedure has already been done on a first level.
This CPT code, 22858, represents a total disc arthroplasty, performed via an anterior approach, at a second cervical interspace.The procedure involves discectomy with endplate preparation, encompassing osteophytectomy for nerve root or spinal cord decompression, and microdissection. This is an add-on code and must be reported with a primary code (22856) for the initial interspace procedure. The surgeon removes the degenerated disc, removes bone spurs (osteophytes) to decompress the nerve root or spinal cord, and then implants an artificial mobile disc to restore normal disc movement. The anterior approach involves an incision in the anterior neck, careful dissection through tissues to protect vital structures (carotid vessels, esophagus, trachea), and retraction of tissues to expose the prevertebral space.Microdissection is performed to meticulously clear the disc space before implanting the artificial disc.The procedure may also include the placement of a supportive plate on the anterior aspect of the adjacent vertebral bodies. This is often indicated in cases of multilevel disc herniations, osteophytes, or spinal cord compression.
Example 1: A 55-year-old patient presents with chronic neck pain and neurological symptoms due to multilevel cervical disc degeneration (C5-C6, C6-C7).A total disc arthroplasty (22856) is performed at the C5-C6 level, and due to significant pathology at C6-C7, a second-level arthroplasty (22858) is added during the same session., A 60-year-old patient with severe cervical spondylosis and radiculopathy undergoes a cervical discectomy and fusion (CDF) at the C5-C6 level.During the same surgical session, the surgeon decides to perform a total disc arthroplasty at the C6-C7 level (22858) due to severe disc herniation and spinal cord compression., A patient with severe cervical disc herniation at two levels (C4-C5 and C5-C6) causing significant myelopathy undergoes a staged surgical intervention. The first stage comprises a total disc arthroplasty at C4-C5 (22856), followed by a second stage at C5-C6 level (22858) during the same surgical session given the extensive disease.
Preoperative imaging (X-rays, CT, MRI) demonstrating multilevel cervical disc degeneration, herniation, or spondylosis.Operative report detailing the approach, disc removal, osteophytectomy, decompression, and implantation of the artificial disc.Intraoperative imaging (fluoroscopy) to confirm placement of the artificial disc.Postoperative imaging to assess the surgical outcome.Patient's history and physical examination findings supporting the diagnosis and medical necessity of the procedure.
** This code is for use only when performing a second level cervical disc replacement in conjunction with a primary code 22856.
- Revenue Code: P3D (MAJOR PROCEDURE, ORTHOPEDIC - OTHER)
- RVU: This information is not available in the provided text.Consult the official CPT codebook or a relevant fee schedule for RVU values.
- Global Days: The global period for this procedure would depend on the specific payer's guidelines.Consult the payer's policy for details.
- Payment Status: Active
- Modifier TC rule: This code does not have a technical component (TC) modifier associated with it.
- Fee Schedule: The historical fee schedule information is not available in the provided text.This will vary by payer and date.
- Specialties:Orthopedic Surgery, Neurosurgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center