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An osteotomy of the spine is a surgical procedure that involves the removal of a portion of a vertebra to correct spinal deformities, such as a flexion deformity. This procedure aims to realign the affected vertebral segment, thereby improving the overall function and stability of the spine while alleviating associated pain. The surgery is performed using a posterior or posterolateral approach, which entails making an incision directly over the affected vertebral segment or just lateral to it. This approach allows for direct access to the vertebra while minimizing damage to surrounding tissues.
During the procedure, the fascia is incised, and a subperiosteal dissection is conducted along the spinal process, lamina, and both transverse processes, as well as the rib head of the vertebral segment, as necessary. A wedge of bone is then resected, which may involve excising portions of the supraspinatus and infraspinatus ligaments and spinous processes. The surgeon carefully repositions the patient and applies manual pressure at the osteotomy site until the opposing ligaments tear, ensuring that nerve roots and other vital structures are kept under direct visualization to prevent any impingement during the manipulation of the vertebra. Once the bony gap created by the wedge resection is closed, additional stabilization methods, such as separately reportable bone grafts and/or spinal instrumentation, may be employed. To ensure proper healing and immobilization of the spine, a body cast or jacket may be applied as needed. This procedure is coded as CPT® 22216 for each additional vertebral segment after the first, with specific codes designated for osteotomies of one cervical, thoracic, or lumbar segment.
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The osteotomy of the spine is indicated for various conditions that necessitate the correction of spinal deformities. These may include:
The procedure for spinal osteotomy involves several critical steps to ensure successful correction of the deformity. The steps include:
Post-procedure care following a spinal osteotomy is crucial for recovery and may include monitoring for complications, managing pain, and ensuring proper immobilization of the spine. Patients may require a period of rehabilitation to regain strength and mobility. The application of a body cast or jacket is often necessary to maintain spinal stability during the healing process. Follow-up appointments will be essential to assess the healing of the osteotomy site and the overall alignment of the spine. Any signs of complications, such as infection or improper healing, should be promptly addressed by the healthcare provider.
| Short Descr | INCIS ADDL SPINE SEGMENT | Medium Descr | OSTEOT SPI PST/PSTLAT APPR 1 VRT SGM EA VRT SGM | Long Descr | Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; each additional vertebral segment (List separately in addition to 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 | 6 | 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.
| 22210 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; cervical | 22212 | MPFS Status: Active Code APC C CPT Assistant Article Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; thoracic | 22214 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; lumbar |
| AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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. | GC | This service has been performed in part by a resident under the direction of a teaching physician | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 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. | 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. | 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). | 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. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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 | 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.) | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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.) | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | ET | Emergency services | GW | Service not related to the hospice patient's terminal condition | LT | Left side (used to identify procedures performed on the left side of the body) |
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| 2013-01-01 | Changed | Short Descriptor changed. |
| 2011-01-01 | Changed | Short description changed. |
| 2010-01-01 | Changed | Code description changed. |
| 1996-01-01 | Added | First appearance in code book in 1996. |
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