Summary & Overview
CPT 22860: Lumbar Total Disc Arthroplasty, Second Interspace
CPT code 22860 covers an anterior approach total disc arthroplasty performed on a second lumbar interspace during the same operative session as a primary arthroplasty. This code matters nationally because lumbar total disc replacement is a specialized spinal procedure with implications for surgical planning, device utilization, and payer policy on concurrent-level arthroplasty services. Coverage and payment policies for concurrent spine arthroplasty can affect access to multi-level surgical care and hospital resource use.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on the clinical service and typical sites of care, an outline of common billing modifiers associated with spinal arthroplasty claims, and national benchmarking context where available. The report summarizes how CPT code 22860 is used in multi-level lumbar arthroplasty cases and highlights areas where payers commonly apply medical review or payment bundling.
This publication provides clinical context for coders and billing managers, practical notes on claim configuration for concurrent-level lumbar arthroplasty, and a policy-oriented summary of payer approaches and coverage considerations at the national level. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 22860 describes a total disc arthroplasty performed at a second interspace in the lower back during the same session as a primary arthroplasty service. The provider approaches the lumbar spine from the front (anterior approach), excises the native intervertebral disc, and replaces it with an artificial disc implant.
Service type: Surgical — lumbar total disc arthroplasty (second-level, concurrent with primary arthroplasty)
Typical site of service: Inpatient or outpatient hospital operating room or ambulatory surgery center, with an anterior lumbar approach
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45–60-year-old adult with symptomatic single-level degenerative disc disease or symptomatic disc herniation at a lumbar interspace who previously underwent or is undergoing a primary lumbar total disc arthroplasty at an adjacent interspace during the same operative session. The patient presents with chronic low back pain, axial mechanical pain unresponsive to conservative care (physical therapy, pain injections, medications) and imaging (MRI/CT) demonstrating disc degeneration or focal disc pathology appropriate for total disc replacement.
Preoperative workflow includes outpatient evaluation by a spine surgeon (orthopedic spine or neurosurgery), imaging review, informed consent discussing risks/benefits/alternatives, and medical clearance. On the day of surgery the patient undergoes general endotracheal anesthesia and is positioned supine. The surgeon performs an anterior retroperitoneal or transperitoneal abdominal approach to the lumbar spine, exposes the target disc space, excises the native disc, prepares vertebral endplates, and implants an artificial disc device at the second interspace. Intraoperative steps often include fluoroscopic confirmation of level and implant position. Postoperative workflow includes PACU recovery, early mobilization per surgeon protocol, and discharge planning with activity restrictions and outpatient follow-up for wound check and imaging as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
62 | Two surgeons | When two surgeons of different specialties perform distinct, necessary parts of the procedure (e.g., vascular surgeon for anterior access plus spine surgeon for implant). |