CPT® Code 0656T

Anterior lumbar or thoracolumbar vertebral body tethering (AVT), also referred to as vertebral body tethering (VBT), is a surgical procedure designed as an alternative to traditional spinal fusion. This technique is specifically utilized to address severe and progressive scoliosis affecting the lumbar or thoracolumbar regions of the spine. One of the primary advantages of tethering is its ability to correct spinal deformities while preserving the natural growth and mobility of the spine, which is particularly important in pediatric patients. The procedure is indicated exclusively for children and adolescents who possess sufficient growth potential, allowing for continued spinal development post-surgery. During the procedure, a flexible cord or cable is strategically placed to facilitate gradual correction of the scoliosis. The surgical approach involves making two small incisions, each measuring approximately 2.5 cm, located over the 10th rib and the L3-L4 intervertebral disc. Through these incisions, endoscopic instruments are introduced to perform the necessary surgical tasks. The procedure includes the placement of anchors and bone screws on the outer side of the spinal curvature, followed by the securing of the tether cord to these screws using additional set screws. The surgeon then applies tension to the tether cord, which initiates a partial straightening of the spine. As the patient continues to grow, the tether cord will further guide the vertebrae into a straighter alignment, promoting ongoing correction of the spinal curvature. The duration of the procedure varies, with single curve corrections typically taking two to three hours, while double curve corrections may extend to four to six hours. In cases where both thoracic and lumbar curves are addressed, instrumentation is required on both sides of the T12 vertebral body. For coding purposes, CPT® Code 0656T is used for tether placement involving up to seven vertebral segments, while CPT® Code 0657T is designated for procedures involving eight or more vertebral segments.