CPT® Code 0790T

Official Description

Revision (eg, augmentation, division of tether), replacement, or removal of thoracolumbar or lumbar vertebral body tethering, including thoracoscopy, when performed

Common Language Description

The CPT® Code 0790T refers to the procedure involving the revision, replacement, or removal of thoracolumbar or lumbar vertebral body tethering (VBT). This procedure is particularly relevant for patients who have undergone previous VBT treatment, which is primarily utilized for managing adolescent idiopathic scoliosis. VBT serves as an alternative to traditional spinal fusion, allowing for the preservation of natural spinal growth and mobility. The procedure is specifically indicated for children and young adolescents who still possess sufficient growth potential. During the initial VBT procedure, small screws are inserted into the affected vertebrae, and a flexible cord, known as a tether, is placed to facilitate scoliosis correction. The tether is strategically tightened to compress the growth plates on the convex side of the spinal curve, thereby inhibiting growth in that area, while being loosened on the concave side to promote continued growth. As the patient matures, adjustments to the tether may be necessary to accommodate ongoing growth. Although revisions are infrequently required, occurring in fewer than 10% of cases, they may be necessary due to complications such as overcorrection, cord breakage, or dislodged screws. In such instances, the surgeon typically employs the same anterior approach utilized during the initial surgery, which may involve a mini-open thoracoabdominal exposure or a thoracoscopic technique to access the spine for the necessary corrections.

1. Indications

The procedure described by CPT® Code 0790T is indicated for specific conditions related to the management of adolescent idiopathic scoliosis. The following are the explicitly provided indications for performing this procedure:

Revision of Vertebral Body Tethering - This procedure is indicated when there is a need to revise a previously implanted vertebral body tether due to complications such as overcorrection or cord breakage.
Replacement of Vertebral Body Tethering - Replacement may be necessary if the existing tether has become ineffective or damaged, requiring a new tether to be implanted.
Removal of Vertebral Body Tethering - Removal is indicated in cases where the tether is no longer needed or if it has caused complications, such as dislodged screws.

2. Procedure

The procedure for CPT® Code 0790T involves several critical steps that ensure the effective revision, replacement, or removal of the vertebral body tethering. Each step is detailed as follows:

Step 1: Anesthesia Administration - The patient is placed under general anesthesia to ensure comfort and immobility during the procedure.
Step 2: Surgical Access - The surgeon utilizes a mini-open thoracoabdominal exposure or a thoracoscopic technique to access the thoracolumbar or lumbar spine. This approach allows for minimal disruption of surrounding tissues while providing adequate visibility and access to the vertebrae.
Step 3: Identification of Tethering Components - Once access is achieved, the surgeon carefully identifies the existing tethering components, including the screws and the tether itself, to assess their condition and determine the necessary actions for revision, replacement, or removal.
Step 4: Revision or Replacement - If revision is required, the surgeon may adjust the tether to correct any overcorrection or loosen it if necessary. In cases of replacement, the damaged tether is removed, and a new tether is implanted, ensuring proper placement and tension.
Step 5: Closure - After the necessary adjustments or replacements are made, the surgical site is closed using standard closure techniques, ensuring that the incision is secure and healing is facilitated.

3. Post-Procedure

Post-procedure care following the revision, replacement, or removal of vertebral body tethering is crucial for optimal recovery. Patients are typically monitored in a recovery area until they are stable. Pain management is addressed, and patients may be prescribed analgesics as needed. Physical therapy may be recommended to aid in recovery and to promote mobility. Follow-up appointments are essential to monitor the surgical site for any signs of complications and to assess the effectiveness of the procedure. Patients are advised on activity restrictions to prevent undue stress on the spine during the initial healing phase. Additionally, adjustments to the tether may be required in future visits as the patient continues to grow.

Short Descr	REVJ RPLCMT/RMVL VRT TETHRG
Medium Descr	REVJ RPLCMT/RMVL TLMBR/LMBR VRT BODY TETHERING
Long Descr	Revision (eg, augmentation, division of tether), replacement, or removal of thoracolumbar or lumbar vertebral body tethering, including thoracoscopy, when performed
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