Summary & Overview
CPT 22848: Spinal Fixation Attachment to Pelvis, Excluding Coccyx
CPT code 22848 denotes surgical fixation in which the lower end of a spinal fixation device is attached to the pelvic bones (ilium) but not to the coccyx, commonly performed during multilevel spinal fusion or arthrodesis to provide distal anchorage. This code is nationally relevant due to the clinical importance of pelvic fixation in complex spinal deformity, revision, and long-segment fusion cases, and because it influences surgical coding, hospital billing, and payer coverage determinations across inpatient and outpatient surgical settings. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, typical sites of service, and the clinical context for its use. The publication provides benchmarks and policy-related notes relevant to coding and coverage practices, highlights areas where coding clarification is commonly needed, and summarizes clinical scenarios that commonly generate use of this code. Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, and related codes is noted where applicable. This summary is written for a national audience seeking clarity on clinical intent, billing classification, and payer considerations for pelvic anchorage of spinal instrumentation.
Billing Code Overview
CPT code 22848 describes the surgical attachment of the lower end of a spinal fixation device to the pelvic bones (ilium), explicitly excluding attachment to the tailbone (coccyx). This procedure is performed as part of spinal surgery such as spinal fusion or arthrodesis to provide distal pelvic anchorage for spinal instrumentation.
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Service type: Surgical implant fixation of spinal instrumentation to the pelvis during spinal fusion/arthrodesis
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Typical site of service: Hospital operating room or ambulatory surgical center for spine surgery
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with multilevel degenerative lumbar spondylosis and symptomatic spinal instability presents after failed conservative care (physical therapy, epidural steroid injections). Imaging demonstrates L4–S1 degenerative disc disease with L5–S1 instability and high-grade sacral alar insufficiency. The surgical plan is a posterior lumbar fusion extending to the pelvis with placement of iliac or sacral-alar-iliac pelvic fixation screws to secure the distal construct. In the operating room under general anesthesia, the spine surgeon exposes the posterior elements, performs decompression and interbody fusion as indicated, and attaches the lower end of the spinal fixation construct to the pelvic bones (ilium/sacral-alar-iliac) without directly instrumenting the coccyx. Intraoperative fluoroscopy confirms screw trajectory and hardware position. Postoperative workflow includes immediate PACU recovery, postoperative radiographs, inpatient pain management and mobility training, and discharge planning with outpatient follow-up for wound check and imaging.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased Procedural Services | Use when work, time, and complexity substantially exceed the usual for 22848 (document detailed operative report). |