Overview:
The fiscal year 2022 ICD-10-PCS code set updates [1] address the lack of a specific code for vertebral body tethering performed in the treatment of scoliosis. Scoliosis is a condition that manifests in a significant number of skeletally immature patients annually and is generally defined as an abnormal curvature of the spine greater than ten degrees. Well known complications of scoliosis include lung and heart damage due to restriction of the rib cage, chronic back pain over time, and psychosocial issues regarding one’s physical appearance.
The Tether™ – Vertebral Body Tethering System [2] is a non-fusion spinal device indicated for skeletally immature patients that require surgical treatment to obtain and maintain correction of progressive idiopathic scoliosis. The Tether™ – Vertebral Body Tethering System is different from the other surgical treatments for scoliosis, such as spinal fusion, because the spine is still able to bend and flex. Rather than stiff metal rods, The Tether™ – Vertebral Body Tethering System uses a strong, flexible cord to pull on the outside of a scoliosis curve to straighten out the spine. The Tether™ – Vertebral Body Tethering System received FDA approval on August 16, 2019.
Procedure Details:
Anchors and vertebral body screws are placed laterally from a thoracoscopic or thoracotomy approach into the vertebral body on the convex side of a spinal deformity. A SULENE® polyethylene terephthalate (PET) tensioning cord is secured to the vertebral body screws with set screws to connect the levels of the construct. The device provides a lateral tension band across the convex side of the spine that, on insertion and tensioning, partially corrects the curvature, and subsequently can arrest or correct the deformity through modulation of remaining spinal growth using a process called “growth modulation.” When the vertebrae are pulled by the cord, it puts pressure on the tall side of the vertebra on the outside of the curve. This pressure slows the growth on the tall side of the vertebra, so that the short side can grow and catch up. After surgery, the spine may continue to straighten even more over time as the patient grows. If over-correction is observed, it is possible to surgically sever the tensioning cord, eliminating the lateral tension band effect.
Current Coding:
Today, the use of a vertebral body tether is coded with the applicable ICD-10-PCS code(s) from tables 0PS and 0QS, Reposition of Upper and Lower Bones, using the device value 4 Internal Fixation Device.
FY 2022 Coding:
Revisions have been made to Table 0PS (Reposition of Upper Bones) and 0QS (Reposition of Lower Bones) to provide the specificity necessary to capture vertebral body tethering procedures. The table excerpts below illustrate these changes. Please note, the FY22 updates did not include the new device character under the root operations for removal (P) or revision (R). Therefore, any removal or revision of a vertebral body tethering system will require the use of the device character 4 (Internal Fixation Device).
Section 0 Medical and Surgical
Body System P Upper Bones
Operation S Reposition: Moving to its normal location, or other suitable location, all or a portion of a body part
| Body Part | Approach | Device | Qualifier |
| 0 Thoracic Vertebra | 0 Open 4 Percutaneous Endoscopic | 3 Spinal Stabilization Device, Vertebral Body Tether 4 Internal Fixation Device Z No Device | Z No Qualifier |
Section 0 Medical and Surgical
Body System Q Lower Bones
Operation S Reposition: Moving to its normal location, or other suitable location, all or a portion of a body part
| Body Part | Approach | Device | Qualifier |
| 0 Lumbar Vertebra | 0 Open 4 Percutaneous Endoscopic | 3 Spinal Stabilization Device, Vertebral Body Tether 4 Internal Fixation Device Z No Device | Z No Qualifier |
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