Use This Total Disc Arthroplasty Guide to Nail Claims
Make sure claim proves medical necessity for TDA. Total disc arthroplasty (TDA), also known as artificial disc replacement (ADR), offers a motion-preserving alternative to fusion by substituting a degenerated intervertebral disc with a prosthetic implant. For coders, capturing TDA accurately goes beyond selecting the correct CPT® and ICD-10-CM codes — you must also understand key anatomical considerations, know how documentation links to payer policy, and analyze if medical necessity is demonstrated. Read on for more information to correctly code TDAs. Anatomy Knowledge Essential for TDA Coding Before you assign any codes, it’s crucial to recognize why certain levels and conditions matter. In the cervical spine (C3-C7), discs consist of a central nucleus pulposus surrounded by annulus fibrosus rings. A typical scenario is a C5-C6 herniation compressing the C6 nerve root, manifesting as arm pain or numbness. Surgeons approach this via an anterior route, remove the disc material and osteophytes, and prepare the end plates until they bleed which is critical to prevent the prosthesis from sinking. If advanced facet or uncovertebral arthritis appear at that level, the segment loses motion, rendering ADR contraindicated. In the lumbar spine (L3-S1), L4-L5 and L5-S1 bear most of the load, making them common sites for degeneration. A herniation at L4-L5 typically pinches the L5 nerve root, causing sciatica. In this case, surgeons access the disc anteriorly — carefully displacing the aorta, vena cava, and peritoneum — to perform a complete discectomy and thorough end‐plate prep. Again, if imaging shows severe facet arthropathy or fused facets, it means motion is impaired and the ADR is not viable. Understanding these anatomic “stop signs” helps you verify whether a case truly meets TDA criteria. Check Out These CPT® Codes for TDA Once you identify the levels, next comes choosing the appropriate CPT® code for the TDA. For a single‐level cervical TDA, use 22856 (Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); single interspace, cervical). If two contiguous cervical levels are addressed in the same session (e.g., C5-C6 and C6-C7), include +22858 (… second level, cervical (List separately in addition to code for primary procedure)). For a later revision at one cervical level, use 22861 (Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical) and report +0098T (Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, cervical (List separately in addition to code for primary procedure)) for each additional level. To remove an existing prosthesis without replacement, report 22864 (Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical) and report +0095T (Removal of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, cervical (List separately in addition to code for primary procedure)) for each additional level. In the lumbar spine, 22857 (Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression); single interspace, lumbar) covers a single‐level ADR (complete discectomy, end‐plate prep, and fluoroscopic placement). Two adjacent levels (such as L4-L5 and L5-S1) require 22857 and +22860 (Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression); second interspace, lumbar (List separately in addition to code for primary procedure)). For revisions of a lumbar ADR, use 22862 (Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar) with +0165T (Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, lumbar (List separately in addition to code for primary procedure)) for any additional levels. For removal-only procedures, use 22865 (Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar) plus +0164T (Removal of total disc arthroplasty, (artificial disc), anterior approach, each additional interspace, lumbar (List separately in addition to code for primary procedure)) for each additional level. Remember: For the above codes, always list the base code first (for example 22856 or 22857), before any applicable add-on codes. Also, do not bill fluoroscopy or end-plate prep separately — those are bundled into the primary ADR codes. Take These ICD-10-CM Considerations Into Account Coders should base ICD-10-CM code assignment on the surgeon’s documented postoperative findings, rather than independently interpreting the imaging. When the surgeon’s note specifies a clinical diagnosis such as, “C5–C6 disc herniation with C6 radiculopathy,” report M50.122 (Cervical disc disorder at C5-C6 level with radiculopathy). If the surgeon documents “lumbar disc herniation at L4-L5 with L5 nerve-root compression,” assign M51.16 (Intervertebral disc disorders with radiculopathy, lumbar region). Should the surgeon describe, “severe degeneration at L5-S1 causing mechanical low back pain” without specific radiculopathy, use M51.37- (Other intervertebral disc degeneration, lumbosacral region). Bottom line: In every case, ensure that the ICD-10-CM codes directly reflect the level and combined clinical picture recorded in the surgeon’s operative or consultation note, since this documentation is the definitive source for clinical diagnosis. Check Out These LCD-Driven Documentation Essentials Local coverage determinations (LCDs) specify medical necessity criteria. When it comes to TDA, almost all LCDs insist that the chart include the following: Note: This is what most LCDs will require for a TDA claim. Always check your individual payer contract if you have any questions about submitting a TDA claim. Omitting these elements can trigger denials or delays, so remember to cross-check the note against LCD requirements. By combining solid anatomical knowledge with precise CPT and ICD-10-CM coding, and by ensuring your documentation aligns with LCD medical-necessity guidelines, you set yourself up for a clean audit and timely reimbursement. Be sure to verify every detail — failed conservative care dates, imaging-exam correlation, contraindication exclusions, mandatory surgical phrases, and a clear postoperative plan — to create a payer-friendly, audit-ready claim. Jennifer McNamara, CPC, CPC-I, CCS, CRC, CPMA, CDEO, COSC, CGSC, COPC, 
Document dates, treatments, and patient responses.
Tie the surgeon’s exam findings directly to the level and laterality noted on imaging.
Explicitly note stability, facet status, and bone density to confirm eligibility.
Ensure the operative note contains specific LCD‐required steps so reviewers know the procedure met standards.
A concise postoperative plan shows appropriate case management and follow-up.
CEO and Director of Education at Healthcare Inspired LLC
