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Anterior lumbar or thoracolumbar vertebral body tethering (AVT), also referred to as vertebral body tethering (VBT), is a surgical procedure designed as an alternative to traditional spinal fusion. This technique is specifically utilized to address severe and progressive scoliosis affecting the lumbar or thoracolumbar regions of the spine. One of the primary advantages of tethering is its ability to correct spinal deformities while preserving the natural growth and mobility of the spine, which is particularly important in pediatric patients. The procedure is indicated exclusively for children and adolescents who possess sufficient growth potential, allowing for continued spinal development post-surgery. During the procedure, a flexible cord or cable is strategically placed to facilitate gradual correction of the scoliosis. The surgical approach involves making two small incisions, each measuring approximately 2.5 cm, located over the 10th rib and the L3-L4 intervertebral disc. Through these incisions, endoscopic instruments are introduced to perform the necessary surgical tasks. The procedure includes the placement of anchors and bone screws on the outer side of the spinal curvature, followed by the securing of the tether cord to these screws using additional set screws. The surgeon then applies tension to the tether cord, which initiates a partial straightening of the spine. As the patient continues to grow, the tether cord will further guide the vertebrae into a straighter alignment, promoting ongoing correction of the spinal curvature. The duration of the procedure varies, with single curve corrections typically taking two to three hours, while double curve corrections may extend to four to six hours. In cases where both thoracic and lumbar curves are addressed, instrumentation is required on both sides of the T12 vertebral body. For coding purposes, CPT® Code 0656T is used for tether placement involving up to seven vertebral segments, while CPT® Code 0657T is designated for procedures involving eight or more vertebral segments.
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The procedure of anterior lumbar or thoracolumbar vertebral body tethering (AVT) is indicated for specific conditions and patient demographics. The following are the explicitly provided indications for this procedure:
The anterior lumbar or thoracolumbar vertebral body tethering procedure involves several critical steps, each designed to ensure effective correction of spinal curvature while preserving growth potential. The following procedural steps are outlined:
Post-procedure care for patients undergoing anterior lumbar or thoracolumbar vertebral body tethering is essential for optimal recovery and outcomes. While specific post-operative instructions may vary based on individual patient needs and surgeon preferences, general considerations include monitoring for any signs of complications, managing pain, and ensuring proper wound care. Patients are typically advised to follow up with their healthcare provider for regular assessments of spinal alignment and growth progress. Rehabilitation may be recommended to support recovery and enhance mobility. The gradual correction of the spinal curvature will continue as the patient grows, necessitating ongoing evaluation to ensure the tethering remains effective.
| Short Descr | ANT LMBR VRT BDY TETH <7 SEG | Medium Descr | ANT LUMBAR/TLMBR VRT BODY TETHRG <7VRT SEG | Long Descr | Anterior lumbar or thoracolumbar vertebral body tethering; up to 7 vertebral segments | Status Code | Carriers Price the Code | Global Days | YYY - Carrier Determines Whether Global Concept Applies | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply 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 | Inpatient Procedures, not paid under OPPS | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. |
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| 2025-01-01 | Changed | Short Description changed. |
| 2024-01-01 | Changed | Medium and Long Descriptions changed. Guideline information changed. |
| 2022-01-01 | Added | First appearance in codebook. |
| 2021-07-01 | Added | Code added. |
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