CPT® Code 0165T

Add-On Code

1. Indications

The procedure described by CPT® Code 0165T is indicated for patients who require revision of a previously implanted total disc arthroplasty in the lumbar region. This may be necessary due to various complications or failures associated with the artificial disc, including:

• Implant Malposition: The artificial disc may have become unseated or improperly positioned between the vertebrae, necessitating adjustment or replacement.
• Component Failure: One or more components of the artificial disc may have failed, leading to pain, instability, or other functional impairments.
• Adhesions or Fibrous Tissue Formation: The presence of adhesions or fibrous tissue around the implant can complicate its function and may require surgical intervention to resolve.
• Persistent Pain or Symptoms: Patients experiencing ongoing pain or neurological symptoms despite the presence of the artificial disc may require revision surgery to address underlying issues.

2. Procedure

The procedure for CPT® Code 0165T involves several critical steps to ensure the successful revision and replacement of the total disc arthroplasty:

• Step 1: Anterior Approach - The surgeon begins by making an incision in the abdomen to access the lumbar spine. This anterior approach allows for direct visualization and manipulation of the intervertebral space.
• Step 2: Retraction of Muscles - Once the abdominal cavity is accessed, the intervertebral muscles are carefully retracted to expose the artificial disc. This step is essential for gaining access to the surgical site without causing unnecessary damage to surrounding tissues.
• Step 3: Identification and Exploration - The surgeon identifies the artificial disc and explores the surrounding area. Any adhesions or fibrous tissue that may have formed around the implant are meticulously freed to allow for a clear view and access to the implant.
• Step 4: Distraction of Intervertebral Space - Distraction is applied to open the intervertebral space, which is crucial for assessing the position of the implant and preparing for any necessary adjustments or replacements.
• Step 5: Reseating or Replacement of Implant - If the implant is found to be unseated, it may be reseated into its proper position. If the implant or its components are determined to be malfunctioning, they are removed, and the interspace is prepared for the insertion of a new prosthesis or component.
• Step 6: Insertion of New Prosthesis - The new implant or component is carefully seated into the prepared interspace, ensuring proper alignment and stability.
• Step 7: Closure - After the new implant is in place, the surgeon repairs the fascia and muscle tissue. The incision is then closed, and a drain may be left in place to prevent fluid accumulation and promote healing.

3. Post-Procedure

Post-procedure care following the revision of a total disc arthroplasty includes monitoring for any complications, managing pain, and ensuring proper healing of the surgical site. Patients may be advised to follow specific activity restrictions to allow for optimal recovery. Physical therapy may be recommended to aid in rehabilitation and to restore function. The presence of a drain may require additional care to ensure it is functioning correctly and to prevent infection. Follow-up appointments will be necessary to assess the success of the procedure and to monitor the condition of the new implant.