The group of CPT codes that deal with major surgical procedures in the spine (22100-22889) (graft codes) were revised during 1994-1995 by a work group from the American Association of Neurological Surgeons (AANS) and the American Academy of Orthopaedic Surgeons (AAOS). The codes for preparation and harvesting of bone grafts for spinal procedures (20930-20938) were also revised to more clearly distinguish the actual service involved.
The object was to provide for the changes in surgical technology and procedures that have evolved over the past ten years while improving the accuracy and specificity of the descriptors of the services covered by each code. Use of older CPT codes/descriptors was resulting in a failure to accurately portray the real scope of services frequently delivered to a patient in a single surgical session for management of a complex spinal problem. Misuse and misinterpretation of some of the codes also led to cumulative charges and bills that became an embarrassment to those who were called upon to defend such behavior.
An agreement was reached with the CPT committee of the AAOS to refine these codes in a manner that would allow for each delivered service to be reported and billed, but which would more fairly apportion the value of each such service within the total package provided. This “Chinese menu” style of unbundling these codes encourages a building block technique in coding for a collection of services provided during the course of a single operative session.
After the CPT codes were reviewed and approved by the CPT Editorial Panel of the American Medical Association (AMA), they were forwarded to the AMA RVS Update Committee (RUC) for review and revaluation of the physician work component. Fifty-five codes were in this package, and required a survey by the orthopedists and neurosurgeons who provided these services. This was completed last Spring and presented to the RUC. The survey results led to relatively small changes in the physician relative values for work (RVWs) for the majority of the codes.
Instrumentation Codes Reduced
However, the spinal instrumentation codes were a part of this review and revaluation, and were reduced in their RVWs by 50%. The reasons for this decrease were based on the initial valuation of these codes in the CPT 1994 as a group of procedures to be used in addition to another code such as an arthrodesis, and was valued for physician work to cover only those services up to and including the day of surgery (000 Global) with the aftercare apportioned to the primary code (arthrodesis). The RUC agreed that these codes should be reclassified as add-on services with a ZZZ Global period, which meant that only the intra-operative service for the instrumentation would be apportioned as physician work.
The result of this change was a reduction in the adjusted RVW of 50%. This was the final agreement that was sent to the Health Care Financing Administration (HCFA) and approved after review at that level.
One Last Chapter
There is one more chapter to this story about the instrumentation codes. When HCFA reviewed these codes, there was agreement that they had been re-valued appropriately by reducing the RVUs by 50%. However, HCFA did not apply that same 50% cut to the practice expense RVUs and the malpractice expense RVUs for each of the revised instrumentation codes.
HCFA did a reallocation of the practice expense and malpractice expense RVUs for work, practice expense and malpractice expense to adjust the RVUs in each category. When this was done, the total RVUs for most of the spinal instrumentation codes had been reduced by 60%, which is the current level published by HCFA. Our comments and complaints about this extra reduction have not been accepted as a basis for restoring the extra costs, since HCFA feels that these services were overvalued initially and now are more reasonably valued.
SPINE CPT CODES
| 1996 RVUs-1995 RVUs | |||||||||||||
| CPT | DESCRIPTOR | 96 RVW | 96 RVP | 96 RVM | 96 RVU Total | 96 GLOBAL | RVW | PE | Malp | Total | |||
| 22100 | Remove part of neck vertebra | 9.05 | 7.64 | 1.09 | 17.78 | 90 | 0.86 | 1.27 | 0.26 | 2.39 | |||
| 22101 | Remove part, thorax vertebra | 9.00 | 8.01 | 1.38 | 18.39 | 90 | 0.81 | 1.44 | 0.19 | 2.44 | |||
| 22102 | Remove part, lumbar vertebra | 9.00 | 4.50 | 0.67 | 14.17 | 90 | 0.22 | 0.12 | 0.05 | 0.39 | |||
| 22103 | Remove extra spine segment | 2.34 | 2.23 | 0.37 | 4.94 | ZZZ | |||||||
| 22105 | Remove part of neck vertebra | 0.00 | 0.00 | 0.00 | 0.00 | 90 | |||||||
| 22106 | Remove part, thorax vertebra | 0.00 | 0.00 | 0.00 | 0.00 | 90 | |||||||
| 22107 | Remove part, lumbar vertebra | 0.00 | 0.00 | 0.00 | 0.00 | 90 | |||||||
| 22110 | Remove part of neck vertebra | 11.59 | 9.72 | 1.64 | 22.95 | 90 | |||||||
| 22112 | Remove part, thorax vertebra | 11.59 | 9.90 | 1.63 | 23.12 | 90 | |||||||
| 22114 | Remove part, lumbar vertebra | 1.59 | 7.25 | 1.17 | 20.01 | 90 | 0.00 | -0.11 | 0.02 | -0.09 | |||
| 22116 | Remove extra spine segment | 2.32 | 2.21 | 0.36 | 4.89 | ZZZ | |||||||
| 22140 | Reconstruct neck spine | 0.00 | 0.00 | 0.00 | 0.00 | 90 | |||||||
| 22141 | Reconstruct thorax spine | 0.00 | 0.00 | 0.00 | 0.00 | 90 | |||||||
| 22142 | Reconstruct lumbar spine | 0.00 | 0.00 | 0.00 | 0.00 | 90 | |||||||
| 22145 | Reconstruct vertebra(e) | 0.00 | 0.00 | 0.00 | 0.00 | ZZZ | |||||||
| 22148 | Harvesting bone graft | 0.00 | 0.00 | 0.00 | 0.00 | ZZZ | |||||||
| 22150 | Reconstruct neck spine | 0.00 | 0.00 | 0.00 | 0.00 | 90 | |||||||
| 22151 | Reconstruct thorax spine | 0.00 | 0.00 | 0.00 | 0.00 | 90 | |||||||
| 22152 | Reconstruct lumbar spine | 0.00 | 0.00 | 0.00 | 0.00 | 90 | |||||||
| 22210 | Revision of neck spine | 22.51 | 13.83 | 2.43 | 38.77 | 90 | |||||||
| 22212 | Revision of thorax spine | 18.14 | 17.29 | 2.83 | 38.26 | 90 | |||||||
| 22214 | Revision of lumbar spine | 18.14 | 15.00 | 2.70 | 35.84 | 90 | 0.00 | -0.11 | 0.02 | -0.09 | |||
| 22216 | Revise, extra spine segment | 6.04 | 5.70 | 0.90 | 12.64 | ZZZ | |||||||
| 22220 | Revision of neck spine | 20.15 | 16.64 | 2.63 | 39.42 | 90 | |||||||
| 22222 | Revision of thorax spine | 20.15 | 13.61 | 1.58 | 35.34 | 90 | |||||||
| 22224 | Revision of lumbar spine | 20.15 | 14.68 | 2.66 | 37.49 | 90 | |||||||
| 22226 | Revise, extra spine segment | 6.04 | 5.07 | 0.89 | 12.00 | ZZZ | |||||||
| 22230 | Additional revision of spine | 0.00 | 0.00 | 0.00 | 0.00 | ZZZ | |||||||
| 22305 | Treat spine process fracture | 1.86 | 2.38 | 0.37 | 4.61 | 90 | 1.86 | 2.38 | 0.37 | 4.61 | |||
| 22310 | Treat spine fracture | 1.86 | 2.52 | 0.69 | 5.07 | 90 | 1.86 | 2.52 | 0.69 | 5.07 | |||
| 22315 | Treat spine fracture | 8.36 | 5.51 | 0.86 | 14.73 | 90 | |||||||
| 22325 | Repair of spine fracture | 17.19 | 8.32 | 1.34 | 26.85 | 90 | |||||||
| 22326 | Repair neck spine fracture | 18.43 | 15.93 | 2.74 | 37.10 | 90 | |||||||
| 22327 | Repair thorax spine fracture | 17.56 | 15.95 | 2.35 | 35.86 | 90 | |||||||
| 22328 | Repair each add spine fx | 4.61 | 4.40 | 0.72 | 9.73 | ZZZ | |||||||
| 22505 | Manipulation of spine | 1.77 | 1.31 | 0.17 | 3.25 | ||||||||
| 22548 | Neck spine fusion | 24.08 | 22.74 | 3.82 | 50.64 | 10 | |||||||
| 22554 | Neck spine fusion | 17
 | |||||||||||
