Coding Examples

This list represents coding examples for common spine procedures.
The information can also be used in

conjunction with the Medicare Fee Calculator on www.medtronicsofamordanek.com/spineline to estimate the
amount of physician reimbursement expected from the performance of one or more of these procedures.
LUMBAR
Anterior Lumbar Interbody Fusion (ALIF) with Posterior Instrumentation
Procedure Description CPT® Comments
Anterior Interbody Fusion, Lumbar 22558
22585 each additional interspace
Application of Biomechanical Device (cages, etc.) 22851
22851 59 each additional interspace
Posterior Instrumentation 22840 non-segmental instrumentation
22842 segmental; 3 – 6 vertebral segments
22844 segmental; 13+ vertebral segments
Use of bone graft:
Allograft (morselized) 20930 Add-on code
Allograft (structural) 20931 Add-on code
Autograft (rib/lamina/spinous process, same incision) 20936 Add-on code
Autograft (morselized, separate incision) 20937 Add-on code
Autograft (structural, separate incision) 20938 Add-on code
ALIF with Anterior Instrumentation

Anterior Instrumentation 22845 2 – 3 vertebral segments
22846 4 – 7 vertebral segments
22847 8 or more vertebral segments
Use of bone graft:
ALIF with INFUSE® Bone Graft and LT-CAGE® Lumbar Tapered Fusion Device, Single Level
Placement of osteopromotive material 20930 Add-on code
Note:
code 20930 should be reported for rhBMP ( INFUSE® Bone graft).
LUMBAR (continued)
ALIF and Posterolateral Fusion (Classic 360° Procedure)
Posterolateral Fusion, Lumbar 22612
22614 each additional segment
Anterior Interbody Fusion, Lumbar 22558 51
Use of bone graft:
Posterior Lumbar Interbody Fusion (PLIF) or Transforaminal Lumbar Interbody Fusion (TLIF) with Posterior Instrumentation
Posterior Interbody Fusion, Lumbar 22630
Use of bone graft:
Note: Codes 63030 and 63047 are bundled per the NCCI edits with code 22630. CPT® Assistant (January 2001, page 12) states that
code in this instance).
Laminectomy, Lumbar
Laminectomy without Facetectomy, Foraminotomy or Discectomy, 63005 one or two vertebral segments
Lumbar, except for spondylolisthesis 63017 more than 2 vertebral segments
Laminectomy with removal of abnormal facets and/or pars inter- 63012 Gill-type procedure
articularis with decompression, for spondylolisthesis, lumbar
Laminotomy (hemilaminectomy), including partial facetectomy, 63030 one interspace
foraminotomy and/or excision of herniated disc, lumbar 63035 each additional interspace
Laminotomy (hemilaminectomy), including partial facetectomy, 63042 one interspace
foraminotomy and/or excision of herniated disc, re-exploration, lumbar 63044 each additional interspace
Laminectomy, facetectomy and foraminotomy, lumbar 63047 single vertebral segment
LUMBAR (continued)
PLIF/TLIF and Posterolateral Fusion (Single Incision 360°)
Posterior Interbody Fusion, Lumbar 22630 51
Application of Biomechanical Device (cages, etc) 22851
Use of bone graft:
Note: Codes 63030 and 63047 are bundled per the NCCI edits with code 22630. CPT® Assistant (January 2001, page 12) states that these codes
PLIF with Posterior Instrumentation, via METRx® System/CD HORIZON® SEXTANT® System
Posterior Interbody Fusion, Lumbar 22630
Use of bone graft:
Note: Codes 63030 and 63047 are bundled per the NCCI edits with code 22630. CPT® Assistant (January 2001, page 12) states that these codes
Direct Lateral Fusion with Anterior Instrumentation (DLIF)

22846 4 – 7 vertebral segments
Use of bone graft:
LUMBAR (continued)
Posterolateral Fusion with Posterior Instrumentation
Use of bone graft:
Discectomy, Lumbar
Posterior Discectomy, Lumbar 63030
Note:
Balloon Kyphoplasty
Percutaneous vertebral augmentation, including cavity creation 22523 thoracic
(fracture reduction and bone biopsy included when performed) 22524 lumbar
using mechanical device, one vertebral body, unilateral or bilateral 22523 each additional level
cannulation (e.g., kyphoplasty)
Use of bone graft:

X-STOP®
Allograft (morselized)
Procedure Description 20930
CPT® Add-on codeComments
Insertion
Autograftof(rib/lamina/spinous
posterior spinous process distraction
process, device
same incision) 0171T
20936 Add-on code
(including necessary
Autograft removal
(morselized, of boneor
separate ligament for insertion
incision) 0172T
20937 each additional
Add-on code level
and imaging
Autograft guidance),
(structural, lumbar; incision)
separate single level 20938 Add-on code
Discectomy, Lumbar
Use of bone
Posterior graft: Lumbar
Discectomy, 63030
Note:
CERVICAL
Anterior Cervical Discectomy with Interbody Fusion (ACDF)
Anterior interbody fusion, with discectomy and decompression; 22551
cervical below C2 22552 each additional interspace
22846 4 – 7 vertebral segment
Use of bone graft:

Note: Do not report 22554 or 22585 with 63075 or 63076 even if performed by different physicians. To report anterior cervical
discectomy and interbody fusion at the same level during the same session, use 22551.
Cervical Arthroplasty
Total Disc Arthroplasty, Anterior Approach, Cervical 22856
Laminoplasty
Laminoplasty, Cervical 63050 two or more vertebral segments
With Reconstruction 63051
The materials and information cited here are provided to assist in obtaining coverage and reimbursement for healthcare services. However, there can be
no guarantee or assurances that it will not become outdated, without the notice of Medtronic, or that the government or other payors may not differ
with the guidance contained here. The responsibility for coding correctly lies with the healthcare provider ultimately, and we urge you to consult with
your coding advisors to resolve any billing questions that you may have. All products should be used according to their labeling.
CPT copyright 2009 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable
FARS/DFARS restrictions apply to government use. Fee schedules, relative value units, conversion factors and/or related components are not assigned
by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense
medical services. The AMA assumes no liability for data contained or not contained herein.
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This list represents coding examples for common spine procedures.

The information can also be used in

ALIF with Anterior Instrumentation

code in this instance).

Direct Lateral Fusion with Anterior Instrumentation (DLIF)

Use of bone graft:

Use of bone graft:

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