Summary & Overview
CPT 22858: Cervical Total Disc Arthroplasty, Second Level
CPT code 22858 identifies a second-level cervical total disc arthroplasty performed through an anterior approach during the same operative session as an initial cervical disc replacement. The surgeon removes the degenerated disc and associated osteophytes, decompresses neural elements, and implants an artificial mobile disc to preserve intervertebral motion. This code matters nationally because cervical total disc arthroplasty is a growing alternative to fusion for certain degenerative cervical conditions and affects surgical utilization, payer coverage policies, and device reimbursement across inpatient and ambulatory surgical settings. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, common modifiers used with the code (list provided separately), and an outline of the topics typically covered in benchmarking and policy discussions such as utilization trends, coverage criteria, and coding compliance considerations. Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, related procedure codes, and payer-specific payment amounts are noted as unavailable in the source material.
Billing Code Overview
CPT code 22858 describes a second-level cervical total disc arthroplasty performed at the same operative session as an initial interspace cervical spine total disc arthroplasty. The procedure is performed through an anterior approach, involving removal of the degenerated intervertebral disc, decompression by removing bone spurs or osteophytes from the vertebral endplates, and implantation of an artificial mobile disc to restore motion at the treated interspace.
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Service type: Cervical total disc arthroplasty (second level, same session)
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Typical site of service: Inpatient or outpatient hospital operating room or ambulatory surgery center, performed under general anesthesia
Clinical & Coding Specifications
Clinical Context
A 48-year-old active patient with chronic axial neck pain and radiculopathy refractory to conservative care presents for surgical treatment. Preoperative evaluation including MRI demonstrates symptomatic degenerative disc disease and foraminal stenosis at two adjacent cervical levels, with one level already planned for total disc arthroplasty. At the same operative session, the surgeon elects to perform a second-level anterior cervical total disc arthroplasty at the adjacent interspace to restore motion and decompress neural elements. The procedure is performed under general anesthesia in an ambulatory surgery center or hospital operating room using an anterior cervical approach. The surgeon removes the degenerated disc material, performs necessary discectomy and osteophyte removal (foraminotomy/uncinectomy as indicated), sizes and implants an artificial mobile cervical disc at the second level, confirms positioning with fluoroscopy, and achieves hemostasis. Postoperative care includes short-stay monitoring for airway compromise, neurologic assessment, pain control, and discharge with cervical immobilization or soft collar per surgeon preference. Typical sites of service are the hospital inpatient or outpatient surgery department and ambulatory surgical center.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
62 | Two surgeons | Use when two surgeons of different specialties perform distinct portions of the procedure concurrently (e.g., vascular exposure and arthroplasty). |