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Revenue Recognition
 12 Months Ended
Dec. 31, 2023
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 2023 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.
Beginning in the first quarter 2023 we consolidated Other MedSurg and Neurotechnology into Endoscopy as Other MedSurg and Neurotechnology (primarily Sustainability Solutions) has been fully integrated into our Endoscopy business. Endoscopy includes sales related to Other of $343, $302 and $277 for 2023, 2022 and 2021. We have reflected these changes in all historical periods presented.
Segment Net Sales
MedSurg and Neurotechnology:202320222021
Instruments$2,569 $2,279 $2,111 
Endoscopy3,033 2,725 2,418 
Medical3,459 3,031 2,607 
Neurovascular1,226 1,200 1,188 
Neuro Cranial1,549 1,376 1,214 
$11,836 $10,611 $9,538 
Orthopaedics and Spine:
Knees$2,273 $1,997 $1,848 
Hips1,544 1,413 1,342 
Trauma and Extremities3,147 2,807 2,664 
Spine1,189 1,146 1,167 
Other509 475 549 
$8,662 $7,838 $7,570 
Total$20,498 $18,449 $17,108 
United States Net Sales
MedSurg and Neurotechnology:202320222021
Instruments$2,051 $1,810 $1,637 
Endoscopy2,478 2,211 1,943 
Medical2,785 2,422 2,007 
Neurovascular483 446 451 
Neuro Cranial1,270 1,135 988 
$9,067 $8,024 $7,026 
Orthopaedics and Spine:
Knees$1,676 $1,493 $1,351 
Hips988 896 822 
Trauma and Extremities2,297 2,035 1,866 
Spine883 836 831 
Other346 354 425 
$6,190 $5,614 $5,295 
Total$15,257 $13,638 $12,321 
International Net Sales
MedSurg and Neurotechnology:202320222021
Instruments$518 $469 $474 
Endoscopy555 514 475 
Medical674 609 600 
Neurovascular743 754 737 
Neuro Cranial279 241 226 
$2,769 $2,587 $2,512 
Orthopaedics and Spine:
Knees$597 $504 $497 
Hips556 517 520 
Trauma and Extremities850 772 798 
Spine306 310 336 
Other163 121 124 
$2,472 $2,224 $2,275 
Total$5,241 $4,811 $4,787 
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). 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, 2023 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. This occurs primarily when payment is received upfront for certain multi-period extended warranty service contracts. Our contract liabilities of $860 and $741 on December 31, 2023 and 2022 are classified within accrued expenses and other liabilities and other noncurrent liabilities within our Consolidated Balance Sheets based on the timing of when we expect to complete our performance obligations. Changes in contract liabilities during the year were as follows:
2023
Beginning contract liabilities$741 
Revenue recognized from beginning of year contract liabilities(379)
Net advance consideration received during the period498 
Ending contract liabilities$860