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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 vertebral segments in the thoracic or lumbar spine. This technique involves a lateral approach that necessitates the resection of ribs and exposure of the pleura and/or peritoneum, which is critical for accessing the targeted vertebral segments. The procedure begins with a midline incision that is extended laterally, allowing the surgeon to expose the paraspinous muscle bundle over the vertebral segment intended for fusion. The paraspinous muscles are carefully elevated off the spinous processes and laminae to provide a clear view of the underlying structures. During the operation, the paraspinous muscle bundle is divided and elevated off the ribs, followed by the dissection of the rib from the intercostal muscles and pleura. The rib is then resected, and the intercostal nerve is identified and protected to prevent any nerve damage. A high-speed drill is utilized to remove the associated transverse process and the lateral portion of the facet and pedicle, which exposes 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 interbody arthrodesis, a separately reportable bone allograft or autograft is placed between the vertebral endplates. After the necessary preparations and placements, drains may be inserted as needed, and the incisions are subsequently closed. This code, CPT® 22534, is specifically used to report the arthrodesis of each additional thoracic or lumbar vertebral segment, in conjunction with the primary procedure codes for thoracic and lumbar arthrodesis.
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The procedure is indicated for various conditions affecting the thoracic or lumbar spine that may require stabilization through fusion. The following are explicitly provided indications for performing arthrodesis by lateral extracavitary technique:
The procedure involves several critical steps to ensure successful arthrodesis. Each step is detailed as follows:
Post-procedure care involves monitoring the patient for any complications and ensuring proper recovery. Patients may require pain management and physical therapy to aid in rehabilitation. Follow-up appointments are essential to assess the healing process and the success of the arthrodesis. The expected recovery time may vary based on individual patient factors and the extent of the surgery performed. It is important to provide instructions regarding activity restrictions and signs of potential complications that should prompt immediate medical attention.
| Short Descr | ARTHRD LAT XTRCVTRY TQ EA AD | Medium Descr | ARTHRODESIS LAT EXTRACAVITARY EA ADDL THRC/LMBR | Long Descr | 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) | 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) | 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 | 3 | CCS Clinical Classification | 158 - Spinal fusion |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 22532 | 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 | 22533 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar | 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) | 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) |
| 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 | 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. | 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. | 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. | 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). | RT | Right side (used to identify procedures performed on the right side of the body) | 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 |
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| 2022-01-01 | Note | Short description changed. |
| 2011-01-01 | 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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