Summary & Overview
CPT 22836: Anterior Thoracic Screw Fixation With Flexible Cable for Scoliosis
CPT code 22836 represents anterior thoracic spinal fixation using screws connected by a flexible cable for correction of scoliosis, covering up to seven vertebral segments. The code captures a specialized spinal deformity surgery with implications for surgical planning, facility resource use, and payer coverage policies nationally. Its use is concentrated in orthopedic and neurosurgical spine practices and in hospital-based surgical settings.
Key payers in national analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical and billing overview of the procedure, typical sites of service, commonly reported modifiers, and practical considerations for claims submission and documentation. The publication highlights benchmark metrics, coding notes that affect claim processing, and clinical context on why the code is used for scoliosis-related corrective fixation.
This piece is intended to inform billing professionals, revenue cycle managers, and clinical teams about the code’s clinical purpose, payer coverage landscape, and the types of benchmarks and policy updates that commonly influence reimbursement and utilization decisions. Data not available in the input will be identified where applicable in detailed sections.
Billing Code Overview
CPT code 22836 describes placement of screws in the anterior thoracic vertebrae connected with a flexible cable, a procedure typically performed to address spinal curvature from scoliosis. The code applies to fixation spanning up to seven vertebral segments.
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Service type: Surgical spinal fixation for deformity correction
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Typical site of service: Inpatient or outpatient hospital operating room, specialized spine surgery centers
Clinical & Coding Specifications
Clinical Context
A 13-year-old adolescent with progressive thoracic idiopathic scoliosis presents with a 45-degree right convex thoracic curve and documented progression despite bracing. After clinical evaluation, standing scoliosis radiographs, and preoperative pulmonary and laboratory clearance, the orthopedic spine surgeon schedules anterior thoracic instrumentation using anterior thoracic screws connected with a flexible cable spanning up to seven vertebral segments (22836). The procedure is performed in an operating room at an inpatient hospital or ambulatory surgery center depending on institutional practice and patient factors. General anesthesia with single-lung ventilation may be used for exposure. The workflow includes preoperative imaging review, intraoperative placement of anterior thoracic vertebral screws, passage and tensioning of the flexible cable to correct and stabilize the coronal deformity, intraoperative fluoroscopy to confirm hardware position and curve correction, hemostasis, and layered wound closure. Postoperative care includes monitoring in post-anesthesia care unit or pediatric/adult spine ward, pain control, postoperative radiographs, pulmonary care, and discharge planning with outpatient follow-up for wound check and radiographic surveillance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/No modifier | Use when no modifier applies to the service. |