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The procedure described by CPT® Code 22586 refers to lumbar arthrodesis performed specifically at the L5-S1 interspace using a pre-sacral interbody technique. This technique involves several critical steps, including the preparation of the disc space, discectomy, and the placement of posterior instrumentation, all of which are conducted with the aid of image guidance. The term 'arthrodesis' denotes a surgical procedure aimed at fusing two or more vertebrae, thereby eliminating movement at the joint and providing stability to the spine. In this case, the pre-sacral interbody technique, also known as transsacral or paracoccygeal, is characterized by a minimally invasive approach that allows access to the anterior portion of the disc space through a small incision made near the coccyx. This method is particularly advantageous as it minimizes tissue disruption and can lead to quicker recovery times. The procedure includes the removal of the intervertebral disc material and the preparation of the end plates of the adjacent vertebrae, which is essential for successful fusion. Bone grafts, either from a donor (allografts) or the patient’s own body (autografts), are utilized to facilitate the fusion process. The final steps involve the implantation of posterior fixation devices, such as rods or screws, to ensure stability during the healing process. Overall, this procedure is designed to alleviate pain and restore function in patients suffering from conditions affecting the lumbar spine.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 22586 is indicated for patients experiencing specific conditions affecting the lumbar spine, particularly at the L5-S1 interspace. The following indications may warrant the performance of this procedure:
The procedure involves several key steps that are essential for successful lumbar arthrodesis at the L5-S1 interspace:
After the completion of the procedure, patients typically require monitoring in a recovery area. Post-procedure care may include pain management, physical therapy, and instructions for activity restrictions to promote healing. Patients are often advised to avoid heavy lifting and twisting motions for a specified period. Follow-up appointments are essential to assess the healing process and ensure that the fusion is progressing as expected. Imaging studies may be performed to evaluate the success of the procedure and the integration of the bone grafts.
| Short Descr | ARTHRD PRE-SAC NTRBDY L5-S1 | Medium Descr | ARTHRODESIS PRESACRAL NTRBDY DSC W/INSTRMJ L5-S1 | Long Descr | Arthrodesis, pre-sacral interbody technique, including disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft when performed, L5-S1 interspace | 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) |
| 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. | 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). | 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. | 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 |
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| 2022-01-01 | Note | Short and Medium description changed. |
| 2013-01-01 | Added | Added |
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