Anterior Cervical Discectomy and Fusion (ACDF)
2255122552wRVU: 6.34 — Each additional level (+6.34 wRVU, add-on)22853wRVU: 4.14 — Insertion of interbody biomechanical device (PEEK/synthetic cage; 4.14 wRVU, add-on) — bill with 22551/22552 when a synthetic cage is used; do NOT also bill 20931 for the same interspace22845wRVU: 11.64 — Anterior instrumentation, 2-3 vertebral segments, separate plate (11.64 wRVU, add-on) — only when a separate (non-integrated) anterior plate is applied; 22846 for 4-7 segments, 22847 for 8+ segments22554wRVU: 17.25 — Arthrodesis, anterior, minimal disc preparation only, single space — alternative primary code (17.25 wRVU, 90-day global); mutually exclusive with 22551 for the same level; use only when no therapeutic decompression is performed
Cervical disc herniation / cervical spondylosis with radiculopathy / myelopathy
Same
Anterior cervical discectomy and fusion (ACDF), [C5-6 / C6-7 / specify levels], with anterior plating
[Attending name], MD
[Resident/Fellow/PA name]
General endotracheal
Patient presents with [cervical radiculopathy refractory to ≥6 weeks of conservative management including PT, medications, and/or ESI / cervical myelopathy — no mandatory conservative trial required for myelopathy; surgical intervention is indicated for progressive or significant myelopathy]. MRI demonstrates [disc herniation / spondylotic stenosis] at [C5-6 / C6-7] with [foraminal narrowing / cord compression / T2 cord signal change at level]. [SSEP/MEP] baseline obtained. Risks including dysphagia, hoarseness (RLN injury), esophageal injury, vertebral artery injury, Horner syndrome, postoperative hematoma (airway-threatening), hardware failure, non-union, adjacent segment disease, [C5 palsy (multilevel cases),] and neurological worsening discussed.
After discectomy at [C5-6], [disc herniation / osteophyte complex] confirmed. Dural sac decompressed. Nerve root foramina unroofed bilaterally. Endplates prepared to bleeding bone.
The patient was positioned supine with the neck gently extended. Neuromonitoring baselines established. A transverse incision was made in the right neck crease at the level of [C5-6], approximately 4 cm in length. Platysma divided transversely. The medial border of the sternocleidomastoid was identified and the dissection carried medial to the carotid sheath, retracting it laterally. The esophagus and trachea were retracted medially. The prevertebral fascia was incised.
Fluoroscopic localization confirmed the C5-6 interspace. Self-retaining retractors placed. The anterior disc space was entered with a scalpel and annulotomy performed. The disc was removed with a combination of pituitary rongeurs and curettes. The posterior longitudinal ligament was removed with a Kerrison rongeur. The spinal cord and bilateral nerve roots were visualized and confirmed decompressed. The endplates were prepared with a high-speed drill to bleeding cancellous bone.
A [PEEK / allograft] cage packed with [local autograft (from operative site) / demineralized bone matrix / rhBMP-2 (off-label use in anterior cervical spine — see 2008 FDA Public Health Notification for swelling/airway risk; documented informed consent obtained)] was sized and impacted into the disc space under fluoroscopic guidance with adequate lordosis. A [4-hole] anterior cervical plate was positioned and secured with [4] screws. Fluoroscopy confirmed appropriate hardware positioning and alignment.
The wound was irrigated. Retractors removed. Platysma and skin closed in layers. A drain was [placed / not placed]. Cervical collar applied. Patient tolerated the procedure well.
None
Disc material sent to pathology
Minimal to [X] mL
[Closed suction drain placed / None]
Patient extubated in OR. Taken to PACU / neurosurgical floor in stable condition.
Epic SmartPhrase Version
PREOPERATIVE DIAGNOSIS: Cervical [disc herniation / spondylosis] with [radiculopathy / myelopathy] at ***
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Anterior cervical discectomy and fusion (ACDF), ***, with anterior plating
ATTENDING SURGEON: ***, MD/DO
FIRST ASSISTANT: ***
ANESTHESIA: General endotracheal
INDICATIONS: The patient is a .PTAGE-year-old .PTSEX with cervical [radiculopathy refractory to ≥6 weeks of conservative management / myelopathy (no conservative trial required)]. MRI demonstrates [disc herniation / spondylotic stenosis] at *** with [foraminal narrowing / cord compression / T2 cord signal change]. SSEP/MEP baseline obtained. Risks including dysphagia, hoarseness (RLN injury), esophageal injury, vertebral artery injury, Horner syndrome, postoperative hematoma, hardware failure, non-union, adjacent segment disease, and neurological worsening were discussed. Informed consent obtained.
FINDINGS: After discectomy at ***, [disc herniation / osteophyte complex] confirmed. Dural sac decompressed. Nerve root foramina unroofed bilaterally. Endplates prepared to bleeding cancellous bone. Neuromonitoring stable throughout.
DESCRIPTION OF PROCEDURE:
Patient positioned supine with neck gently extended. Neuromonitoring baselines established. Transverse incision in right neck crease at level of ***, approximately 4 cm. Platysma divided transversely. Dissection carried medial to carotid sheath, retracting it laterally. Esophagus and trachea retracted medially. Prevertebral fascia incised. Fluoroscopic localization confirmed *** interspace. Self-retaining retractors placed. Discectomy performed with pituitary rongeurs and curettes. PLL removed with Kerrison rongeur. Spinal cord and bilateral nerve roots confirmed decompressed. Endplates prepared with high-speed drill to bleeding bone. A [PEEK / allograft] cage packed with [local autograft / BMP / DBM] sized and impacted under fluoroscopic guidance with adequate lordosis. [4-hole] anterior cervical plate secured with [4] screws. Fluoroscopy confirmed hardware position and alignment. Wound irrigated. Platysma and skin closed in layers. Cervical collar applied. Patient tolerated the procedure well.
ESTIMATED BLOOD LOSS: Minimal
SPECIMENS: Disc material to pathology
COMPLICATIONS: None
DRAINS: [Closed suction drain / None]
DISPOSITION: Patient extubated in OR. Taken to PACU in stable condition.
Signed: .ME, .MYDEGREE
.TODAYVariants
Two-level ACDF
Document each level separately. Add CPT 22552 for each additional level. Document independent decompression at each level.
Cervical disc arthroplasty (CDA)
Motion-preserving alternative for selected 1-2 level radiculopathy. CPT 22856 (total disc arthroplasty, single interspace, cervical; 23.45 wRVU, 90-day global). Add-on +22858 for second level. Document device type, size, endplate preparation, segmental mobility confirmed fluoroscopically, and absence of fusion material. No cage code (22853) or plate code (22845) applicable.
Corpectomy
For multilevel disease or OPLL. Document vertebral body removal, strut graft placement, and plating. CPT 63081 (single segment, 25.45 wRVU, 90-day global) + +63082 for each additional segment (4.25 wRVU, add-on). Bill 22554 for the fusion component (22551 is not appropriate when decompression is via corpectomy rather than discectomy). Instrumentation codes 22845-22847 apply separately for the anterior plate.
Charting Tips
- Document neuromonitoring use and any intraoperative changes
- State fluoroscopic level confirmation before skin incision
- Note approach side (right vs left) and structures retracted
- Document PLL removal if performed, as this indicates complete decompression
- State cage material, size, and bone graft used
- Document plate length, screw count, and fluoroscopic confirmation of position
Billing Tips
- Bill 22551 for ACDF at the first level (24.38 wRVU, 90-day global). Bill +22552 as an add-on for each additional level (+6.34 wRVU per level). Document each level treated and independent decompression performed at each level. The add-on code stacks without modifier -51. 22554 (anterior arthrodesis with minimal disc preparation only, without decompression, 17.25 wRVU) is an alternative primary code used when no therapeutic decompression is performed — it is mutually exclusive with 22551 for the same interspace and is NOT an add-on. The vast majority of ACDF procedures use 22551.
- When a PEEK cage or synthetic interbody device is implanted, bill +22853 (insertion of interbody biomechanical device; 4.14 wRVU, add-on) in addition to 22551/22552. This code replaced deleted 22851 in 2017 and is one of the most commonly missed ACDF add-ons. For structural allograft spacers (not synthetic cages), bill +20931 (structural allograft, 1.76 wRVU) instead. Do not bill both 22853 and 20931 for the same interspace.
- Bone graft coding: 20937 (morselized autograft, 2.72 wRVU) and 20938 (structural autograft, 2.94 wRVU) require autograft harvested through a SEPARATE skin incision (e.g., iliac crest). Local autograft from the operative site (osteophyte shavings, drill debris) is coded as 20936, which is NOT separately billable — it is bundled into the primary procedure. Separately billing 20937/20938 for local-site autograft is incorrect. Document harvest site and graft type explicitly.
- Anterior instrumentation (plate): Bill +22845 (2-3 segments, 11.64 wRVU) when a SEPARATE anterior cervical plate is applied. Do not bill 22845 with stand-alone integrated-fixation cages (those are captured by +22853 only). 22846 = 4-7 segments (12.09 wRVU); 22847 = 8+ segments (13.44 wRVU).
- 90-day global period: collar management, physical therapy coordination, and routine follow-up are bundled. Re-operation for pseudarthrosis is a staged planned procedure — modifier -58 (not -78). Dysphagia and hoarseness are common; document preoperative baseline swallowing and voice quality.
General coding reference. Verify with your institution’s billing department before submitting claims.