CPT® Code 0172T | Case2Code

Official Description

Insertion of posterior spinous process distraction device (including necessary removal of bone or ligament for insertion and imaging guidance), lumbar; each additional level (List separately in addition to code for primary procedure)

Common Language Description

The procedure described by CPT® Code 0172T involves the insertion of a posterior spinous process distraction device specifically in the lumbar region of the spine. This procedure is performed at each additional level beyond the primary procedure and includes the necessary removal of bone or ligament to facilitate the insertion of the device, as well as imaging guidance to ensure proper placement. The posterior spinous process distraction device is utilized in the treatment of lumbar stenosis, a condition characterized by the narrowing of the spinal canal, which can lead to pressure on the spinal cord and nerves. This condition is often associated with degeneration of the intervertebral discs and a reduction in disc height, which may result in symptoms such as neurogenic claudication, where patients experience pain or discomfort in the legs during physical activity. During the procedure, a surgical incision is made over the affected intervertebral disc space, allowing access through the subcutaneous tissue and lumbosacral fascia to expose the inferior and superior spinous processes, as well as the interspinous ligament. The surgical team may remove bone from the exposed spinous processes to create sufficient space for the device. Lamina spreaders are then inserted between the lamina of adjacent vertebral segments to apply distraction, thereby enlarging the intervertebral opening. The interspinous ligament may also be excised if necessary. Following the creation of this space, the interspinous distraction device is carefully inserted between the spinous processes into the defect created during the procedure. Once the device is in place, distraction is discontinued, and the lamina spreaders are removed. Throughout the procedure, intraoperative imaging and/or fluoroscopy may be employed to verify the alignment and positioning of the IPD device, ensuring optimal outcomes for the patient. The use of code 0172T is mandated for each additional lumbar level treated with the insertion of the IPD device.

1. Indications

The procedure associated with CPT® Code 0172T is indicated for patients experiencing lumbar stenosis, particularly when accompanied by degeneration of the intervertebral disc and loss of disc height. This condition often leads to neurogenic claudication, which manifests as pain or discomfort in the lower extremities during physical activity. The insertion of a posterior spinous process distraction device is aimed at alleviating these symptoms by decompressing the affected spinal segments and restoring space within the spinal canal.

Lumbar Stenosis Narrowing of the spinal canal in the lumbar region, leading to nerve compression.
Degeneration of Intervertebral Discs Deterioration of the discs that can contribute to spinal instability and stenosis.
Loss of Disc Height Reduction in the height of intervertebral discs, which can exacerbate spinal canal narrowing.
Neurogenic Claudication Symptoms such as pain or discomfort in the legs during physical activity due to nerve compression.

2. Procedure

The procedure for the insertion of a posterior spinous process distraction device involves several critical steps to ensure successful implementation and patient safety. Initially, a surgical incision is made over the targeted intervertebral disc space, allowing access through the subcutaneous tissue and lumbosacral fascia. This incision is carefully extended to expose the inferior and superior spinous processes, as well as the interspinous ligament, which may need to be addressed during the procedure.

Step 1: Incision and Exposure A precise incision is made to access the lumbar spine, exposing the necessary anatomical structures, including the spinous processes and interspinous ligament.
Step 2: Bone Removal If required, bone may be excised from the exposed spinous processes to create adequate space for the insertion of the distraction device.
Step 3: Application of Lamina Spreaders Lamina spreaders are inserted between the lamina of the adjacent vertebral segments to apply distraction, which enlarges the intervertebral opening and facilitates the procedure.
Step 4: Insertion of the IPD Device The interspinous distraction device is carefully inserted between the spinous processes into the surgically created defect, ensuring proper placement.
Step 5: Discontinuation of Distraction Once the device is in place, distraction is discontinued, and the lamina spreaders are removed to complete the procedure.
Step 6: Imaging Guidance Throughout the procedure, intraoperative imaging and/or fluoroscopy may be utilized to confirm the alignment and positioning of the IPD device, ensuring optimal outcomes for the patient.

3. Post-Procedure

After the insertion of the posterior spinous process distraction device, patients may require specific post-procedure care to ensure proper recovery. Monitoring for any signs of complications, such as infection or excessive bleeding, is essential. Patients are typically advised on activity restrictions to allow for healing and to prevent undue stress on the surgical site. Follow-up appointments may be scheduled to assess the effectiveness of the procedure and to monitor the patient's recovery progress. Rehabilitation or physical therapy may also be recommended to aid in recovery and improve functional outcomes.

Short Descr	LUMBAR SPINE PROCESS ADDL
Medium Descr	PST SPINOUS PROCESS DEVICE INSERT LMBR EA LVL
Long Descr	Insertion of posterior spinous process distraction device (including necessary removal of bone or ligament for insertion and imaging guidance), lumbar; each additional level (List separately in addition to code for primary procedure)
Status Code	Carriers Price the Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	9 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Items and Services Packaged into APC Rates
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	P3D - Major procedure, orthopedic - other
MUE	Not applicable/unspecified.
CCS Clinical Classification	164 - Other OR therapeutic procedures on musculoskeletal system