Question CPT code 22845 with 22853

[shughes6560]

I know to bill these codes together the plate and cage need to be separate. One of my surgeons sent me the below message and wanted to see if others feel his description of why he is billing 22845 is warranted.
The screw and washer I use are not integral to the cage (they go directly into the bone, separate from the plate) so it should not be bundled into 22853. The screw and washer acts as a plate to keep the cage in the correct position. Due to its function, I have always thought 22845 was the correct code

 

[NRaizman]

I know to bill these codes together the plate and cage need to be separate. One of my surgeons sent me the below message and wanted to see if others feel his description of why he is billing 22845 is warranted.
The screw and washer I use are not integral to the cage (they go directly into the bone, separate from the plate) so it should not be bundled into 22853. The screw and washer acts as a plate to keep the cage in the correct position. Due to its function, I have always thought 22845 was the correct code

You probably need to send a full operative report. Can't tell based on one sentence.

 

[shughes6560]

You probably need to send a full operative report. Can't tell based on one sentence

Unable to upload the whole note says file is too big. I think this pasted section is what you need to review.
Based on fluoroscopic
imaging using these trials, the appropriate sized cage was selected. This was
filled with 1 mL of Grafton as well as a small BMP. The endplates were prepared
with a rasp. The wound was copiously irrigated. Meticulous hemostasis was
maintained. The cage was then inserted into the disk space. AP and lateral
fluoroscopy demonstrated satisfactory implant positioning. A large fragment
screw and washer were then placed in blocking mode along the anterior superior
S1 vertebral body. Excellent purchase was achieved with this screw. Final AP
and lateral fluoroscopy demonstrated satisfactory implant positioning. The
wound was copiously irrigated. Meticulous hemostasis was maintained.

 

[jodielonkoski]

"The screw and washer I use are not integral to the cage", "The screw and washer acts as a plate to keep the cage in the correct position". To me this reads as conflicting, and that the screw is then integral to keeping the cage in position. Here is the description of the code on codify, specifying screw involvement. I believe it depends on cage type.

The provider inserts a metallic cage or mesh device between two vertebrae and may use screws or flanges to attach it to the front part of the vertebrae; the device maintains the disc space, provides spinal stability, and yet preserves some range of motion, which helps relieve persistent pain caused by a herniated, or bulging, disk or other spinal condition. The provider performs this procedure during a spinal interbody arthrodesis procedure, which is fusion, or permanent joining, of vertebrae over the joint space.


CPT Assistant March 2017 states the following:

Code 22853 includes the integral anterior instrumentation for device anchoring that is part of some devices, such as a screw or flange that goes through the biomechanical device to anchor the cage into the disc space. The device anchoring is not the same as anterior instrumentation, which is reported separately when performed. Anterior instrumentation of the spine is denoted by the ability of the instrumentation to stabilize the spinal segment(s) as a standalone device without the cage present, such as with anterior cervical plating or anterior rod system fixation. If the plate is “integrated”, and only used with the cage to keep it in the disc space and not able to be used as a standalone device for biomechanical support such as in a fracture or deformity, then you would not report 22845 and just 22853 or 22854 only. In addition, use of a posterior instrumentation to stabilize the spinal segment(s), such as posterior lumbar pedicle screw fixation, is reported separately.