Is it appropriate to bill both CPT 22845 (anterior plate and screw system) and CPT 22853 (stand‑alone interbody cage with integral fixation) for a single‑level C6‑7 anterior cervical discectomy and fusion, or should they be considered mutually exclusive and non‑certified?

CPT Coding for Single-Level C6-7 ACDF: 22845 vs 22853

Yes, the recommendation to non-certify both CPT 22845 and 22853 at the same interspace is accurate and appropriate—these codes represent mutually exclusive instrumentation strategies that cannot be billed together for a single level.

The Core Issue: Redundant Instrumentation

CPT 22845 describes a separate anterior plate and screw system placed in addition to an interbody spacer, while CPT 22853 describes a stand-alone interbody cage with integral fixation (integrated screws/blades built into the cage itself). Billing both codes at C6-7 would represent payment for two complete anterior fixation systems at the same level, which is:

• Anatomically redundant
• Not standard surgical practice
• Explicitly addressed by CMS coding guidance

The 2015 CMS Audit Impact

The Centers for Medicare & Medicaid Services conducted a specific audit addressing this exact issue. CMS determined that CPT 22845 should not be used to report integrated instrumentation (plate) with an interbody device 1. The audit clarified that:

• If a stand-alone cage with integral fixation is used, only the cage code applies
• If additional separate anterior instrumentation (plate/screws) is placed in addition to an integrated device, a modifier 59 must be used to justify the unusual circumstance
• Documentation of single-level ACDF with separate anterior instrumentation (22845) decreased by 18.1% from 2015-2019, while ACDF without instrumentation coding increased by 91.5% 1

Clinical Context: Two Valid But Separate Approaches

From a surgical standpoint, both techniques are legitimate options for single-level ACDF 2:

Stand-alone cages (22853):

• Shorter operative time (126 vs 194 minutes) 3
• Shorter hospital stay 3
• Comparable fusion rates 4, 5, 6
• Similar dysphagia rates at long-term follow-up 4, 7

Cage with separate plate (22845):

• May provide better short-term stability in 2-level cases 4
• Recommended for reducing pseudarthrosis risk and maintaining lordosis in 1-level disease 2
• Comparable clinical outcomes to stand-alone constructs 5, 6

The Billing Decision Algorithm

For a single-level C6-7 ACDF, the surgeon must choose ONE of the following:

1. Stand-alone cage with integral fixation → Bill 22853 only
2. Separate cage + separate plate/screw system → Bill 22845 only (in addition to the base ACDF code)
3. Cage alone without any fixation → No instrumentation code

Common Pitfall: The integrated screws/blades in a stand-alone cage (22853) already provide anterior fixation. Adding a separate plate on top of this would be unusual and require specific documentation with modifier 59 to justify why both fixation methods were necessary.

Documentation Requirements

To avoid denials, operative notes must clearly specify:

• The exact type of interbody device used (manufacturer, model)
• Whether the device has integral fixation (screws/blades built-in)
• If a separate plate was used, the specific indication for dual fixation
• Anatomic levels treated

The non-certification recommendation is correct—billing both codes represents duplicate payment for the same service (anterior fixation) and violates CMS coding guidelines established after the 2015 audit 1.