Appropriate CPT Coding for OLLIF

Question:

I have a provider who wants to code 22558 for a procedure that is done posterior only. I am coding as TLIF, posterior interbody fusion with posterolateral fusion and Laminectomy, facetectomy, foraminotomy for decompression with discectomy. He states this is OLLIF not OLIF but still wants 22558. There is no repositioning of the patient. He does not enter the retroperitoneal space. All incisions are done posteriorly. Any guidance?

Answer:

Neither CPT 22558 nor CPT 22633 is appropriate for reporting an OLLIF procedure.

CPT 22558 describes an anterior interbody fusion and requires an anterior or anterolateral approach, typically involving retroperitoneal or transabdominal access. Since OLLIF is performed via a posterior-only, percutaneous approach, it does not meet the criteria for this code.

CPT 22633 describes a posterior interbody fusion combined with posterolateral fusion, typically used for TLIF procedures. However, OLLIF is a distinct technique that does not involve the same surgical exposure or instrumentation as TLIF.

According to CPT Assistant, June 2020, Volume 30, Issue 6, page 14: There is no specific CPT code that accurately describes the OLLIF procedure. Therefore, unlisted code 22899, Unlisted procedure, spine, should be reported. When reporting an unlisted code to describe a procedure or service, it is necessary to submit supporting documentation (e.g., procedure report) with the claim to provide an adequate description of the nature, extent, and need for the procedure, as well as the time, effort, and equipment necessary to provide the service.

Using 22899 ensures accurate representation of the surgical technique and compliance with AMA coding guidance, helping avoid potential denials or audits.

*This response is based on the best information available as of 12/04/25.