CPT® Code 22838

Official Description

Revision (eg, augmentation, division of tether), replacement, or removal of thoracic vertebral body tethering, including thoracoscopy, when performed

Common Language Description

The CPT® Code 22838 refers to the revision, replacement, or removal of thoracic vertebral body tethering (VBT), which is a procedure that may include thoracoscopy when performed. This procedure is specifically designed for patients who have previously undergone vertebral body tethering as a treatment for adolescent idiopathic scoliosis. VBT serves as an alternative to traditional spinal fusion, allowing for the preservation of natural spinal growth and mobility. During the initial procedure, small screws are inserted into the affected vertebrae, and a flexible cord, known as a tether, is placed to correct the spinal curvature associated with scoliosis. The tether is strategically tightened to compress the growth plates on the convex side of the spinal curve, thereby inhibiting growth, while it is loosened on the concave side to permit continued growth. As the patient matures, adjustments to the tether may be necessary to accommodate ongoing spinal development. Although revisions are infrequent, occurring in fewer than 10% of cases, they may be required due to complications such as overcorrection, tether breakage, or dislodged screws. In these instances, the surgeon typically utilizes the same anterior approach as in the original surgery, employing either a mini-open thoracotomy or a thoracoscopic technique to access the spine for necessary corrections. The average age of patients undergoing this procedure is around 12 years, which is prior to the closure of the vertebral growth plates.

1. Indications

The procedure coded as CPT® 22838 is indicated for patients who require revision, replacement, or removal of previously implanted thoracic vertebral body tethering (VBT). This may be necessary due to various complications or issues arising from the initial VBT procedure. The specific indications include:

Overcorrection - Situations where the tether has been tightened excessively, leading to an undesired spinal alignment.
Cord breakage - Instances where the flexible cord used in the tethering process has fractured, necessitating replacement or repair.
Dislodged screws - Cases where the screws that anchor the tether to the vertebrae have become dislodged, requiring surgical intervention to correct the issue.

2. Procedure

The procedure for CPT® 22838 involves several critical steps to ensure the successful revision, replacement, or removal of the thoracic vertebral body tethering. The steps are as follows:

Step 1: Anesthesia Administration - The patient is placed under general anesthesia to ensure comfort and immobility during the procedure.
Step 2: Surgical Access - The surgeon employs an anterior approach to access the thoracic spine. This may involve a mini-open thoracotomy or a thoracoscopic technique, depending on the specific case and the surgeon's preference.
Step 3: Identification of Tether and Screws - Once access is achieved, the surgeon carefully identifies the previously implanted tether and screws. This step is crucial for determining the necessary corrections or replacements.
Step 4: Revision or Removal - The surgeon then proceeds to revise, replace, or remove the tether and screws as indicated. This may involve loosening or tightening the tether, replacing broken components, or re-anchoring dislodged screws.
Step 5: Closure - After the necessary adjustments are made, the surgical site is closed in layers, ensuring proper healing and minimizing complications.

3. Post-Procedure

Following the procedure coded as CPT® 22838, patients typically require monitoring in a recovery area until the effects of anesthesia wear off. Post-operative care may include pain management, physical therapy, and follow-up appointments to assess the success of the revision or replacement. Patients are usually advised on activity restrictions to promote healing and prevent complications. The expected recovery time can vary based on the extent of the procedure and the individual patient's health status, but close monitoring is essential to ensure proper spinal alignment and function as the patient continues to grow.

Short Descr	REV RPLC/RMV THRC VRT TETHRG
Medium Descr	REVJ RPLCMT/RMVL THORACIC VRT BODY TETHERING
Long Descr	Revision (eg, augmentation, division of tether), replacement, or removal of thoracic vertebral body tethering, including thoracoscopy, when performed
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)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met.
Team Surgery (66)	1 - Team surgeons could be paid, though...
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)	none
MUE	1