Summary & Overview
CPT 22102: Lumbar Vertebral Bony Lesion Excision
CPT code 22102 denotes excision of a portion of the posterior element of a single lumbar vertebra to remove a contained bony lesion. This targeted spinal bone procedure is relevant across neurosurgery and orthopedic spine services and matters nationally because it informs coding, billing, and clinical documentation for isolated vertebral lesion removal. Accurate use of the code affects claims processing, surgical case mix reporting, and resource planning for hospitals and ambulatory surgical centers.
Key payers covered in this discussion include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The report outlines how CPT code 22102 is applied across typical inpatient and outpatient surgical settings and highlights clinical context for providers who perform isolated posterior lumbar vertebral lesion excision.
Readers will learn the clinical scope of the procedure, typical sites of service, and the primary considerations for documentation and coding alignment. The publication provides benchmarks and policy-relevant context where available, flags common modifier usage when present in input, and summarizes areas where data is not available. Data not available in the input is noted explicitly to guide readers on gaps in payer-specific pricing, utilization, and diagnosis mapping.
Billing Code Overview
CPT code 22102 describes a surgical procedure in which the provider excises a portion of the posterior element of a single lumbar vertebra to remove a bony lesion or diseased area contained within that bone. This procedure is a localized vertebral lesion excision rather than a multi-level spinal operation.
Service Type: Surgical — spinal bone lesion excision
Typical Site of Service: Hospital inpatient or outpatient surgical suite
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient presents with progressive low back pain localized to the lumbar region with focal tenderness over the L3 vertebra. Imaging (CT and MRI) demonstrates a solitary sclerotic bony lesion within the posterior elements of the L3 vertebra suspicious for an osteoid osteoma vs. metastatic deposit. Conservative measures failed and the multidisciplinary team plans a targeted open or minimally invasive posterior partial vertebral excision (posterior lamina or hemilaminectomy-type excision) of the affected lumbar vertebral posterior element to remove the bony lesion and obtain tissue for pathology.
The clinical workflow includes preoperative evaluation and informed consent, targeted imaging review and localization, general endotracheal anesthesia, prone positioning, fluoroscopic or neuronavigation localization, posterior approach with excision of the diseased portion of the lamina/pars or spinous process as needed, hemostasis, possible intraoperative specimen submission for pathology, and routine postoperative monitoring in PACU with pain control and activity restrictions. The typical site of service is an inpatient or ambulatory surgical center equipped for spine procedures. Payors commonly involved include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier / default status | Rarely billed; reflects standard service when no other modifier applies |
11 | Normal or standard service | Use when procedure is performed as planned without unusual circumstances |
22 | Increased procedural services | Use when work or resources substantially exceed typical for 22102 (document reason) |
52 | Reduced services | Use when the procedure was started but discontinued or only partially performed |
53 | Discontinued procedure | Use when procedure is terminated due to extenuating circumstances prior to completion |
59 | Distinct procedural service | Use when another service on the same date is independent and not normally reported together with 22102 |
62 | Two surgeons | Use when two surgeons with different NPI numbers work together as primary surgeons |
66 | Surgical team | Use when a surgical team approach is documented for complex spine excision |
78 | Return to operating room for related procedure during global period | Use when a related return to OR occurs for a complication during the global period |
79 | (Not listed in provided modifiers) | Data not available in the input. |
LT | Left side | Use when the procedure is performed on the left-sided posterior elements |
RT | Right side | Use when the procedure is performed on the right-sided posterior elements |
TC | Technical component | Use when only the technical component of a service is billed (e.g., facility billing for imaging) |
26 | Professional component | Use when billing only the physician’s professional component (e.g., interpretation or surgeon’s professional fee) |
50 | Bilateral procedure | Use when bilateral posterior vertebral elements are excised during the same operative session |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207L00000X | Orthopedic Spine Surgery | Orthopedic surgeons specializing in spine perform posterior vertebral excisions |
| 2084P0800X | Neurosurgery | Neurosurgeons perform complex spinal bony lesion resections and neural element decompression |
| 2086S0101X | Physical Medicine & Rehabilitation (PM&R) | PM&R physicians manage perioperative rehabilitation and pre/postoperative functional care |
| 207RG0100X | Orthopedic Surgery | General orthopedists with spine focus may perform single-level posterior bone excisions |
| 222100000X | Hospitalist / Perioperative Medicine | Perioperative medical management and clearance for spine surgery |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M86.172 | Chronic osteomyelitis, lumbar vertebra | Infection of the lumbar vertebra requiring surgical debridement or excision of diseased bone |
M85.851 | Other specified disorders of bone, lumbar region | Localized bony disorders potentially requiring excision for diagnosis or symptom relief |
C79.31 | Secondary malignant neoplasm of bone, vertebra | Metastatic lesion to a lumbar vertebra that may require excision for pain control or stabilization |
D16.4 | Benign neoplasm of bone and articular cartilage of vertebral column | Primary benign bone tumor (e.g., osteoid osteoma) localized to a lumbar vertebra often treated with excision |
M48.06 | Spinal stenosis, lumbar region | May coexist when posterior bony lesions contribute to canal compromise and require partial excision |
M41.26 | Other scoliosis, lumbar region | Structural deformity sometimes associated with focal bony lesions requiring targeted excision |
M84.369A | Pathological fracture, vertebrae, lumbar region, initial encounter | Pathologic fracture through a diseased lumbar vertebra that may prompt partial vertebral excision |
R52 | Pain, unspecified | Symptom code often used to support medical necessity for surgical intervention for intractable lumbar pain |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
77012 | CT guidance for localization | Preoperative or intraoperative CT-guided localization of bony lesion if used for targeting |
77002 | Fluoroscopic guidance/fluoroscopy | Intraoperative fluoroscopic imaging to localize the lumbar vertebra and guide excision |
63030 | Laminectomy, single vertebral segment; with decompression of nerve roots | May be performed if neural element decompression is needed in addition to bony lesion excision |
63047 | Laminotomy (hemilaminectomy), one vertebral segment; with decompression of nerve root(s) | Alternative posterior bony removal approach when decompression of a nerve root is required alongside lesion excision |
99223 | Initial hospital care, typically 70 minutes or more | Typical inpatient initial inpatient care code for complex postoperative management following spine excision |
88305 | Surgical pathology, gross and microscopic examination | Submission and evaluation of excised bony lesion for histopathology |