© Copyright 2025 American Medical Association. All rights reserved.
A three-column osteotomy of the spine, commonly known as a pedicle subtraction osteotomy, is a surgical procedure aimed at correcting complex spinal deformities. This specific procedure, identified by CPT® Code 22208, is performed on a single vertebral segment, typically in the thoracic region, utilizing a posterior or posterolateral approach. The spine is anatomically divided into three columns: the anterior column, which consists of the vertebral body; the middle column, made up of two robust pedicles that encase the vertebral foramen through which the spinal cord traverses; and the posterior column, which includes the lamina, two transverse processes, and the spinous process. The necessity for a three-column osteotomy arises in cases of significant spinal deformities, where traditional methods may not suffice. The procedure involves making an incision in the skin over the affected vertebral segment, followed by careful dissection of the fascia and subperiosteal layers to access the spinal structures. The surgical technique requires meticulous resection of the posterior elements of the vertebra while preserving the pedicles, which are crucial for maintaining spinal stability. The ultimate goal of this osteotomy is to realign the spine and restore its normal curvature, thereby alleviating symptoms associated with the deformity. Intraoperative imaging is employed to assess the correction of the deformity, ensuring that the surgical objectives are met effectively.
© Copyright 2025 Coding Ahead. All rights reserved.
The three-column osteotomy of the spine, as described by CPT® Code 22208, is indicated for the correction of complex spinal deformities. These deformities may include conditions such as:
The procedure for a three-column osteotomy of the spine involves several critical steps, each designed to ensure effective correction of the spinal deformity:
Post-procedure care following a three-column osteotomy of the spine involves monitoring the patient for any complications and ensuring proper recovery. Patients may require pain management and physical therapy to aid in rehabilitation. The surgical site will need to be kept clean and dry, and follow-up appointments will be necessary to assess healing and spinal alignment. The expected recovery period can vary based on the individual patient's condition and the extent of the surgery, but close observation is essential to ensure optimal outcomes.
| Short Descr | INCIS SPINE 3 COLUMN ADL SEG | Medium Descr | OSTEOTOMY SPINE POSTERIOR 3 COLUMN EA ADDL SGM | Long Descr | Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral body subtraction); each additional vertebral segment (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | 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 | 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) | 1 - Co-surgeons could be paid, though supporting documentation is required... | 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 | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P3D - Major procedure, orthopedic - other | MUE | 5 | CCS Clinical Classification | 142 - Partial excision bone |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 22206 | MPFS Status: Active Code APC C CPT Assistant Article Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral body subtraction); thoracic | 22207 | MPFS Status: Active Code APC C CPT Assistant Article Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral body subtraction); lumbar |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 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. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2013-01-01 | Changed | Short Descriptor changed. |
| 2011-01-01 | Changed | Short description changed. |
| 2010-01-01 | Changed | Code description changed. |
| 2008-01-01 | Added | First appearance in code book in 2008. |
Get instant expert-level medical coding assistance.