Anterior Cervical Discectomy and Fusion (ACDF)

CPT 22551
Approach Open
Add-on / Variant CPTs
  • 22552 — Each additional level
  • 22845 — Anterior instrumentation, 2-3 vertebral segments
  • 22554 — Arthrodesis, anterior, single space
Preoperative Diagnosis:

Cervical disc herniation / cervical spondylosis with radiculopathy / myelopathy

Postoperative Diagnosis:

Same

Procedure Performed:

Anterior cervical discectomy and fusion (ACDF), [C5-6 / C6-7 / specify levels], with anterior plating

Attending Surgeon:

[Attending name], MD

First Assistant:

[Resident/Fellow/PA name]

Anesthesia:

General endotracheal
Patient supine with neck extended over shoulder roll. Intraoperative fluoroscopy available. Somatosensory and motor evoked potential monitoring used.

Indications:

Patient presents with [cervical radiculopathy / myelopathy] refractory to [X weeks / months] of conservative management including [PT, ESI, medications]. MRI demonstrates [disc herniation / spondylotic stenosis] at [C5-6 / C6-7] with [foraminal narrowing / cord compression]. [SSEP/MEP] baseline obtained. Risks including dysphagia, hoarseness (RLN injury), esophageal injury, vertebral artery injury, hardware failure, non-union, adjacent segment disease, and neurological worsening discussed.

Findings:

After discectomy at [C5-6], [disc herniation / osteophyte complex] confirmed. Dural sac decompressed. Nerve root foramina unroofed bilaterally. Endplates prepared to bleeding bone.

Description of Procedure:

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 / BMP / demineralized bone matrix] 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.

Complications:

None

Specimens:

Disc material sent to pathology

Estimated Blood Loss:

Minimal to [X] mL

Drains:

[Closed suction drain placed / None]

Disposition:

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 / myelopathy] refractory to *** weeks/months of conservative management. MRI demonstrates [disc herniation / spondylotic stenosis] at *** with [foraminal narrowing / cord compression]. SSEP/MEP baseline obtained. Risks including dysphagia, hoarseness (RLN injury), 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
.TODAY
Variants

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. Document device type, size, endplate preparation, and fluoroscopic alignment. No fusion material used.

Corpectomy

For multilevel disease or OPLL. Document vertebral body removal, strut graft placement, and plating. CPT 63081.

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 code for each additional level (+6.34 wRVU per level). Document each level treated. The add-on code stacks without modifier -51.
  • Bill 22554 for cervical interbody fusion without discectomy at the first level (17.25 wRVU) when fusion is performed without disc removal. This is less common than 22551. Confirm the procedure matches the code.
  • Bone graft harvesting (20930-20938) is separately billable when autograft is obtained. If allograft is used, graft material may be a separately billed supply. Confirm with your facility's billing team.
  • 90-day global period: collar management, physical therapy coordination, and routine follow-up are bundled. Postoperative CT or MRI ordered for new neurologic symptoms does not generate a separate surgical fee but does generate a radiology fee.
  • Dysphagia and hoarseness are common postoperative complications. Document preoperative baseline swallowing function and voice quality. These findings affect medicolegal risk and outcomes documentation.