Osteotomy

22100 Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; cervical

22101 thoracic

22102 lumbar

✚ 22103 each additional segment (List separately in addition to code for primary procedure)

22110 Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; cervical

22112 thoracic

22114 lumbar

✚ 22116 each additional vertebral segment (List separately in addition to code for primary procedure)

Coding Atlas

An osteotomy is an excision of bone. Vertebral osteotomy is performed in order to correct a misalignment of the spine. Correction may require arthrodesis, bone graft, or placement of spinal instrumentation. Any one of these procedures is reported in addition to the osteotomy procedure.

22206 Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/

vertebral body subtraction); thoracic

22207 lumbar

✚ 22208 each additional vertebral segment (List separately in addition to code for primary procedure)

22210 Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; cervical

22212 thoracic

22214 lumbar

✚ 22216 each additional vertebral segment (List separately in addition to primary procedure)

21920—22216

Musculoskeletal System

Netter’s Atlas of Surgical Anatomy for CPT Coding

48 Moderate sedation ✚Add-on code ^Modifier 51 exempt #Resequenced code

FIGURE 2-15. Anatomy of the Spine

The bony spine can be divided into five segments: cervical (neck), thoracic (upper back), lumbar (lower back), sacrum (base of spine), and coccyx (tailbone). Bones of the spine are called vertebrae.

The space between vertebrae is filled with a cushioning intervertebral disc. The discs have a tough outer shell (annulus) and a gel-filled center (nucleus). The spinal cord runs through the vertebral column. Procedures on the spinal cord are reported using codes for the Nervous System.

Left lateral view

Cervical curvature

Thoracic curvature

Lumbar curvature

Sacral curvature C7

T1 Atlas (C1) Axis (C2)

T12 L1

Sacrum (S1–5)

Coccyx

Vertebral body

Vertebral foramen Pedicle

Transverse process Superior articular

process Lamina Spinous process

Inter- vertebral disc Vertebral body

Pedicle Superior articular process Transverse process Spinous process Accessory process

Inferior vertebral notch

Intervertebral foramen

Articular facet for sacrum L2 vertebra: Superior view

Lumbar vertebrae, assembled:

Left lateral view

Superior vertebral notch Inferior articular process 1

2 3 4

Facets of superior articular processes

Dorsal surface

Posterior superior view

Transverse process of coccyx

Coccygeal cornu (horn) Sacral cornu (horn) Auricular surface

Sacral tuberosity Lateral sacral crest Median sacral crest Intermediate sacral crest

Sacral hiatus

Posterior sacral foramina

Left lateral view (partially sectioned in median plane)

Spinal cord and ventral rami in situ Muscles of the back: Intermediate layers

Inferior articular process

Superior articular process

Transverse process Spinous process Ligamentum flavum

Interspinous ligament Supraspinous ligament Intervertebral foramen

Capsule of zygapophyseal joint (partially opened) Anterior

longitudinal ligament

Anterior longitudinal ligament

Posterior longitudinal ligament Lumbar vertebral body Intervertebral disc

Erector spinae muscle

Iliocostalis muscle Longissimus muscle Spinalis muscle Serratus posterior superior muscle

Splenius capitis and splenius cervicis muscles Superior nuchal line of skull Posterior tubercle of atlas (C1) Longissimus capitis muscle Semispinalis capitis muscle

Serratus posterior inferior muscle Tendon of origin of transversus abdominis muscle Internal oblique muscle

External oblique muscle (cut)

Iliac crest

Thoracolumbar fascia (posterior layer) (cut) Transversus abdominis muscle and tendon of origin

Spinous process of T12 vertebra Iliocostalis lumborum muscle Longissimus thoracis muscle Spinalis thoracis muscle Iliocostalis thoracis muscle Iliocostalis cervicis muscle Longissimus cervicis muscle Spinous process of C7 vertebra Spinalis cervicis muscle Semispinalis capitis muscle (cut) Longissimus capitis muscle Obliquus capitis inferior muscle Rectus capitis posterior major muscle Obliquus capitis superior muscle Rectus capitis posterior minor muscle

C1 spinal nerve C8 spinal nerve T1 spinal nerve

Intercostal nerves

T12 spinal nerve

Conus medullaris Cauda equina S1 spinal nerve Sacrum (cut away) Internal terminal filum (pial part) Termination of dural sac

External terminal filum (dural part)

C1 vertebra (atlas) Cervical plexus T1 vertebra

Brachial plexus Spinal dura mater

Lumbar plexus L1 vertebra

Sacral plexus

Coccyx Costo-

vertebral joints

Continued on next page

Netter’s Atlas of Surgical Anatomy for CPT Coding

Musculoskeletal System

Left lateral view

Cervical curvature

Thoracic curvature

Lumbar curvature

Sacral curvature C7

T1 Atlas (C1) Axis (C2)

T12 L1

Sacrum (S1–5)

Coccyx

Vertebral body

Vertebral foramen Pedicle

Transverse process Superior articular

process Lamina Spinous process

Inter- vertebral disc Vertebral body

Pedicle Superior articular process Transverse process Spinous process Accessory process

Inferior vertebral notch

Intervertebral foramen

Articular facet for sacrum L2 vertebra: Superior view

Lumbar vertebrae, assembled:

Left lateral view

Superior vertebral notch Inferior articular process 1

2 3 4

Facets of superior articular processes

Dorsal surface

Posterior superior view

Transverse process of coccyx

Coccygeal cornu (horn) Sacral cornu (horn) Auricular surface

Sacral tuberosity Lateral sacral crest Median sacral crest Intermediate sacral crest

Sacral hiatus

Posterior sacral foramina

Left lateral view (partially sectioned in median plane)

Spinal cord and ventral rami in situ Muscles of the back: Intermediate layers

Inferior articular process

Superior articular process

Transverse process Spinous process Ligamentum flavum

Interspinous ligament Supraspinous ligament Intervertebral foramen

Capsule of zygapophyseal joint (partially opened) Anterior

longitudinal ligament

Anterior longitudinal ligament Posterior longitudinal ligament Lumbar vertebral body Intervertebral disc

Erector spinae muscle

Iliocostalis muscle Longissimus muscle Spinalis muscle Serratus posterior superior muscle

Splenius capitis and splenius cervicis muscles Superior nuchal line of skull Posterior tubercle of atlas (C1) Longissimus capitis muscle Semispinalis capitis muscle

Serratus posterior inferior muscle Tendon of origin of

transversus abdominis muscle Internal oblique muscle

External oblique muscle (cut)

Iliac crest

Thoracolumbar fascia (posterior layer) (cut) Transversus abdominis muscle and tendon of origin

C1 spinal nerve C8 spinal nerve T1 spinal nerve

Intercostal nerves

T12 spinal nerve

Conus medullaris Cauda equina S1 spinal nerve Sacrum (cut away) Internal terminal filum (pial part) Termination of dural sac

External terminal filum (dural part)

C1 vertebra (atlas) Cervical plexus T1 vertebra

Brachial plexus Spinal dura mater

Lumbar plexus L1 vertebra

Sacral plexus

Coccyx Costo-

vertebral joints

FIGURE 2-15. Anatomy of the Spine (continued)

50 Moderate sedation ✚Add-on code ^Modifier 51 exempt #Resequenced code

Musculoskeletal System

Netter’s Atlas of Surgical Anatomy for CPT Coding

22220 Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; cervical

22222 thoracic

22224 lumbar

✚ 22226 each additional vertebral segment (List separately in addition to code for primary procedure)

Fracture and/or Dislocation

Coding Atlas

Vertebral fractures sometimes occur in combination with vertebral dislocations because when the bone is broken, ligaments holding the bone in place may be severed and the bone may dislodge when it becomes unmoored. In many cases, fracture or dislocation reduction is combined with arthrodesis, bone graft, or placement of spinal instrumentation to complete the correction. Any one of these procedures is reported in addition to the reduction.

22305 Closed treatment of vertebral process fracture(s) 22310 Closed treatment of vertebral body fracture(s), without

manipulation, requiring and including casting or bracing 22315 Closed treatment of vertebral fracture(s) and/or

dislocation(s) requiring casting or bracing, with and including casting and/or bracing by manipulation or traction

22318 Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation;

without grafting 22319 with grafting

22325 Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; lumbar

22326 cervical

22327 thoracic

✚22328 each additional fractured vertebra or dislocated segment (List separately in addition to code for primary procedure)

Incision site

C2 Paraspinous

muscles (retracted) Vertebral lamina Ligamentum flavum Vertebral spine Interspinous ligament Atlantoaxial Paraspinous muscles

Vertebral lamina

FIGURE 2-16. Posterior Approach to the Cervical Spine

One advantage to the posterior approach to the spine is the proximity of the spine to the surface of the skin. The posterior approach for spinal surgery is the most common approach, and the length of the incision is dependent on the size of the defect and the purpose of the surgery. Note: Tools, implants, and/or equipment depicted in the illustration may be outdated but the procedural approach is valid.

Netter’s Atlas of Surgical Anatomy for CPT Coding

Musculoskeletal System

22220—22328

Manipulation

22505 Manipulation of spine requiring anesthesia, any region

Percutaneous Vertebroplasty and

Dalam dokumen Netter's Atlas of Surgical Anatomy for CPT® Coding (Halaman 71-75)