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Revenue Recognition
 12 Months Ended
Dec. 31, 2022
Revenue Recognition [Abstract]  
Revenue Recognition REVENUE RECOGNITION
We disaggregate our net sales by product line and geographic location for each of our segments as we believe it best depicts how the nature, amount, timing and certainty of our net sales and cash flows are affected by economic factors.
Products and services are primarily transferred to customers at a point in time, with some transfers of services taking place over time. In 2022 less than 10% of our sales were recognized as services transferred over time. Refer to Note 1 for further discussion on our revenue recognition policies.
Segment Net Sales
MedSurg and Neurotechnology:202220212020
Instruments$2,279 $2,111 $1,863 
Endoscopy2,423 2,141 1,763 
Medical3,031 2,607 2,524 
Neurovascular1,200 1,188 973 
Neuro Cranial1,376 1,214 972 
Other302 277 250 
$10,611 $9,538 $8,345 
Orthopaedics and Spine:
Knees$1,997 $1,848 $1,567 
Hips1,413 1,342 1,206 
Trauma and Extremities2,807 2,664 1,722 
Spine1,146 1,167 1,047 
Other475 549 464 
$7,838 $7,570 $6,006 
Total$18,449 $17,108 $14,351 
United States Net Sales
MedSurg and Neurotechnology:202220212020
Instruments$1,810 $1,637 $1,471 
Endoscopy1,914 1,670 1,408 
Medical2,422 2,007 1,910 
Neurovascular446 451 381 
Neuro Cranial1,135 988 801 
Other297 273 247 
$8,024 $7,026 $6,218 
Orthopaedics and Spine:
Knees$1,493 $1,351 $1,170 
Hips896 822 777 
Trauma and Extremities2,035 1,866 1,139 
Spine836 831 764 
Other354 425 387 
$5,614 $5,295 $4,237 
Total$13,638 $12,321 $10,455 
International Net Sales
MedSurg and Neurotechnology:202220212020
Instruments$469 $474 $392 
Endoscopy509 471 355 
Medical609 600 614 
Neurovascular754 737 592 
Neuro Cranial241 226 171 
Other5 4 3 
$2,587 $2,512 $2,127 
Orthopaedics and Spine:
Knees$504 $497 $397 
Hips517 520 429 
Trauma and Extremities772 798 583 
Spine310 336 283 
Other121 124 77 
$2,224 $2,275 $1,769 
Total$4,811 $4,787 $3,896 
MedSurg and Neurotechnology
MedSurg and Neurotechnology products include surgical equipment and navigation systems (Instruments), endoscopic and communications systems (Endoscopy), patient handling, emergency medical equipment, intensive care disposable products and clinical communication and workflow solutions (Medical), minimally invasive products for the treatment of acute ischemic and hemorrhagic stroke (Neurovascular), a comprehensive line of products for traditional brain and open skull based surgical procedures; orthobiologic and biosurgery
products, including synthetic bone grafts and vertebral augmentation products (Neuro Cranial) and other medical device products used in a variety of medical specialties. Substantially all MedSurg and Neurotechnology sales are recognized when a purchase order has been received and control has transferred. For certain Endoscopy, Instruments and Medical services, we may recognize sales over time as we satisfy performance obligations that may include an obligation to complete installation, provide training and perform ongoing services, generally performed within one year.
Orthopaedics and Spine
Orthopaedics and Spine products consist primarily of implants used in hip and knee joint replacements and trauma and extremity surgeries, and cervical, thoracolumbar and interbody systems used in spinal injury, deformity and degenerative therapies. Substantially all Orthopaedics sales are recognized when we have received a purchase order and appropriate notification the product has been used or implanted. Substantially all Spine sales are recognized when a purchase order has been received and control has transferred. For certain Orthopaedic products in the "other" category, we recognize sales at a point in time, as well as over time for performance obligations that may include an obligation to complete installation and provide training and ongoing services. Performance obligations are generally satisfied within one year.
Contract Assets and Liabilities
The nature of our products and services do not generally give rise to contract assets as we typically do not incur costs to fulfill a contract before a product or service is provided to a customer. Our costs to obtain contracts are typically in the form of sales commissions paid to employees or third-party agents. Certain sales commissions paid to employees prior to recognition of sales are recorded as contract assets. We expense sales commissions associated with obtaining a contract at the time of the sale or as incurred as the amortization period is generally less than one year. These costs have been presented within selling, general and administrative expenses. On December 31, 2022 contract assets recorded in our Consolidated Balance Sheets were not significant.
Our contract liabilities arise as a result of consideration received from customers at inception of contracts for certain businesses or where the timing of billing for services precedes satisfaction of our performance obligations. We generally satisfy performance obligations within one year from the contract inception date. Our contract liabilities were $741 and $529 on December 31, 2022 and 2021. Changes in contract liabilities during the year were as follows:
2022
Beginning contract liabilities$529 
Revenue recognized from beginning of year contract liabilities(329)
Contract liabilities acquired80 
Net advance consideration received during the period461 
Ending contract liabilities$741