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Arthrodesis by lateral extracavitary technique, including minimal discectomy to prepare the interspace (other than for decompression), is a surgical procedure aimed at fusing vertebrae in the lumbar region of the spine. This technique involves a lateral approach, which necessitates the resection of ribs and exposure of the pleura and/or peritoneum to access the targeted vertebral segment. The procedure begins with a midline incision that is extended laterally, allowing the surgeon to expose the paraspinous muscle bundle over the lumbar vertebrae intended for fusion. The paraspinous muscles are carefully elevated off the spinous processes and laminae, and the muscle bundle is divided to facilitate access to the ribs. The ribs are dissected from the intercostal muscles and pleura, and subsequently resected, while ensuring that the intercostal nerve is identified and protected throughout the process. A high-speed drill is utilized to remove the transverse process and the lateral portions of the facet and pedicle, exposing the dural sac and vertebral body. In cases involving the lumbar spine, the peritoneum is also exposed and retracted to enhance visibility of the vertebral body. The procedure includes the removal of degenerated disc material to prepare the interspace for arthrodesis, followed by the decortication of the vertebral endplates. To facilitate the fusion, a bone graft, either allograft or autograft, is placed between the endplates. The procedure concludes with the placement of drains as necessary and closure of the incisions. This code is specifically designated for lumbar arthrodesis, distinguishing it from thoracic arthrodesis, which is reported with a different code.
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The procedure of arthrodesis by lateral extracavitary technique is indicated for various conditions affecting the lumbar spine. These may include:
The arthrodesis procedure using the lateral extracavitary technique involves several critical steps:
After the arthrodesis procedure, patients typically require monitoring for any complications and may need to follow specific post-operative care instructions. Expected recovery includes managing pain, monitoring for signs of infection, and ensuring proper healing of the surgical site. Physical therapy may be recommended to aid in rehabilitation and restore mobility. The duration of recovery can vary based on individual patient factors and the extent of the surgery performed.
| Short Descr | ARTHRD LAT XTRCVTRY TQ LMBR | Medium Descr | ARTHRODESIS LATERAL EXTRACAVITARY LUMBAR | Long Descr | Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar | Status Code | Active Code | Global Days | 090 - Major Surgery | 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) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | 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 | 1 | CCS Clinical Classification | 158 - Spinal fusion |
This is a primary code that can be used with these additional add-on codes.
| 20705 | Add-on Code MPFS Status: Active Code APC N Removal of drug-delivery device(s), intra-articular (List separately in addition to code for primary procedure) | 20930 | Addon Code MPFS Status: Bundled Code APC N ASC N1 CPT Assistant Article Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure) | 20931 | Addon Code MPFS Status: Active Code APC N ASC N1 CPT Assistant Article Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure) | 20936 | Addon Code MPFS Status: Bundled Code APC N ASC N1 CPT Assistant Article Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary procedure) | 20937 | Addon Code MPFS Status: Active Code APC N ASC N1 CPT Assistant Article Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or fascial incision) (List separately in addition to code for primary procedure) | 20938 | Addon Code MPFS Status: Active Code APC N ASC N1 CPT Assistant Article Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision) (List separately in addition to code for primary procedure) | 20939 | Addon Code MPFS Status: Active Code APC N ASC N1 Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision (List separately in addition to code for primary procedure) | 22534 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting Illustration for Code Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic or lumbar, each additional vertebral segment (List separately in addition to code for primary procedure) | 22840 | Addon Code MPFS Status: Active Code APC N ASC N1 Physician Quality Reporting CPT Assistant Article Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) | 22841 | Addon Code MPFS Status: Bundled Code APC C Physician Quality Reporting CPT Assistant Article Internal spinal fixation by wiring of spinous processes (List separately in addition to code for primary procedure) | 22842 | Addon Code MPFS Status: Active Code APC N ASC N1 Physician Quality Reporting CPT Assistant Article Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) | 22843 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral segments (List separately in addition to code for primary procedure) | 22844 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 13 or more vertebral segments (List separately in addition to code for primary procedure) | 22845 | Addon Code MPFS Status: Active Code APC N ASC N1 Physician Quality Reporting CPT Assistant Article Illustration for Code Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure) | 22846 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Anterior instrumentation; 4 to 7 vertebral segments (List separately in addition to code for primary procedure) | 22847 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Anterior instrumentation; 8 or more vertebral segments (List separately in addition to code for primary procedure) | 22848 | Addon Code MPFS Status: Active Code APC N Physician Quality Reporting CPT Assistant Article Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum (List separately in addition to code for primary procedure) | 22853 | CPT Add On MPFS Status: Active Code APC N ASC N1 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) | 22854 | CPT Add On MPFS Status: Active Code APC N ASC N1 Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to vertebral corpectomy(ies) (vertebral body resection, partial or complete) defect, in conjunction with interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure) | 22859 | CPT Add On CPT Resequenced MPFS Status: Active Code APC N ASC N1 Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure) |
| AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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). | 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. | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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). | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | GZ | Item or service expected to be denied as not reasonable and necessary | RT | Right side (used to identify procedures performed on the right side of the body) | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2022-01-01 | Changed | Short description changed. |
| 2022-01-01 | Note | Short description changed. |
| 2007-01-01 | Changed | Code description changed. |
| 2004-01-01 | Added | First appearance in code book in 2004. |
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