2 + Level ACDF


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If you are coding a 2 or more level ACDF and are needing to use the cpt code 22851, is it OK to code it as 22851 and then again using the -59 modifier for each additional level? Or is this a CPT where we are only allowed to use this once per case? I have always coded it using the -59 modifier for each additional level. And actually have attended an AANS conference where they suggested this as well. But it was recently brought to my attn that I have been coding this incorrectly. Just would like to get some additional feedback. Thanks for your help. :)


True Blue
North Carolina
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You are correct. Per CPT Assistant 1997...

CPT code 22851 should only be reported one time, regardless if one or more metal cages are placed in the intervertebral space at the same level. However, if metal cages are placed at two different levels, (eg, metal cage placed at L3-4 interspace and L5-S1 interspace), then 22851 may be reported more than once to indicate that one or more cages were placed at two or more different levels.

This is also supported by the AANS and NASS...

I, also, report the additional level with modifier 59.