Facilities Payment, Avoid Denials by Using Current Codes
New codes pertinent to neurosurgeons are published in Current Procedural Terminology 2009. The changes include new category I codes for cervical total disc arthroplasty, and a complete revision of the stereotactic radiosurgery codes. In addition, there are new codes for disc aspiration and for the presacral approach to anterior lumbosacral fusion.
Revamped Radiosurgery Codes. The most significant change for 2009 is the revamped radiosurgery codes. With the evolution of framed and frameless systems, a new code (61800 with 3.93 relative value units) was developed for placement of the stereotactic frame. Frame placement previously was bundled into code 61793. For spinal applications, the initial lesion treated with radiosurgery is coded 63620 with 20.28 RVUs. Subsequent lesions to a maximum of five are described by code 63621, with total RVUs of 6.37. For cranial radiosurgery, a pair of codes was developed for simple as well as complex lesions. The initial simple lesion is coded 61796 with 20.28 RVUs. Additional lesions up to five are coded as 61797 with 5.54 total RVUs per lesion.
Cervical Total Disc Arthroplasty. The single level placement of a cervical total disc arthroplasty and its related procedures now have become category I codes. The first placement of a cervical total disc arthroplasty is described using code 22856, and includes discectomy, end plate preparation and osteophytectomy for decompression; this procedure received 43.15 total RVUs. In contrast, an anterior cervical discectomy and arthrodesis with bone allograft is valued at 55.26 RVUs. Although both anterior cervical discectomy and anterior cervical arthrodesis were recently reexamined and revalued in 2007 by the CMS, this code pair currently is being reexamined by the Relative Value Scale Update Committee. The revision of a cervical total disc arthroplasty is coded 22861 at 52.24 total RVUs, and the removal of a cervical total disc arthroplasty is coded 22864 with 48.51 total RVUs. Since the Food and Drug Administration approved single interspace surgery, additional levels of treatment remain category III codes.
Unilateral Posterior Cervical or Lumbar Discectomy. A minor revision was made to the description of code 63020, which formerly delineated a unilateral posterior cervical discectomy. Although the description for unilateral posterior lumbar discectomy (code 63030) was revised several years ago to include an open or endoscopic approach, the CPT editorial panel did not apply the same change to the parent code, 63020. This oversight has been corrected for 2009, allowing either open or endoscopic approaches to be used for either unilateral posterior cervical or lumbar discectomy.
Percutaneous Intervertebral Disc Biopsies. Although percutaneous intervertebral disc biopsies to diagnose discitis have been performed for decades, there has not been a code to describe this procedure. Beginning in 2009, percutaneous aspiration of the disc or paravertebral tissue for diagnostic purposes is coded 62267 at 4.38 total facility RVUs. Category III codes to describe the presacral approach to anterior lumbosacral fusion (e.g. AxiaLIF—TranS1 Inc., Wilmington, N.C.) include 0195T for the initial interspace including discectomy, instrumentation and imaging as well as 0196T for each additional interspace.
It is important for neurosurgeons performing these procedures to quickly adapt their practices to these new codes and code revisions. Early adoption will facilitate proper payment and avoid needless denials. Although the values for radiosurgery are significantly lower than those recommended by the Relative Value Scale Update Committee, every effort will be made to work with CMS to restore a more appropriate valuation. The AANS/CNS Coding and Reimbursement Committee already has written to the CMS concerning this matter.
Gregory J. Przybylski, MD, amember of the AANS NeurosurgeonEditorial Board, is chair of the AANS/CNS Coding and Reimbursement Committee and represents the AANS on the American Medical Association’s Relative Value Scale Update Committee. He instructs coding courses for the AANS and for the North American Spine Society. He is 2nd vice-president of NASS, a member of the Practicing Physicians Advisory Council to the Centers for Medicare and Medicaid Services, and an advisory board member at United HealthCare and Humana Inc.
| Down the Code Road Code development and valuation typically begin within the specialty societies. The AANS/CNS Coding and Reimbursement Committee is the main source for neurosurgery codes, although other groups also develop codes pertinent to neurosurgeons. For example, the CRC supported the North American Spine Society in its development of the new codes for disc aspiration and for the presacral approach to anterior lumbosacral fusion. Neurosurgery has representatives on the American Medical Association’s Relative Value Scale Update Committee, which provides recommendations to the Centers for Medicare and Medicaid Services for use in its annual updates to the new Medicare Relative Value Scale. Category III codes are not evaluated through the Relative Value Scale Update Committee and are not assigned a value by CMS. The AMA publishes Current Procedural Terminology, which is maintained by the CPT Editorial Panel. |
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Coding Q&A
Coding Q&A is an extra feature of the Coding Clarity department. Send your coding concerns to [email protected] with Coding Q&A in the subject line and your question may be answered in an upcoming issue of the AANS Neurosurgeon. Q. Do you have any guidance or reference you could provide regarding anterior instrumentation (code 22845) done without arthrodesis? I’m specifically looking at a new procedure using the Nitinol staple system (Medtronic Sofamor Danek, Memphis, Tenn.), which repairs scoliosis by placement of staples. I saw information in the AANS Neurosurgeon on the new add-on status for the instrumentation codes: “Although intuitively it would seem that these codes [22840-22847] should be added on to arthrodesis codes, there are examples of decompression with interbody placement of polymethylmethacrylate without arthrodesis but with instrumentation. I recommend that your coding staff review the list of primary procedures with which instrumentation codes can be used.” Any help would be greatly appreciated. We have co-surgeons doing
this procedure thoracoscopically and aren’t sure whether the arthrodesis
code (22810) should be used for the approach, vertebral orientation,
and stabilization (which would allow code 22845 to be billed in addition),
or whether we’re required to bill an unlisted code and forego the
instrumentation (stapling). A. Instrumentation codes can be used with certain decompression codes as well as arthrodesis codes, as listed in the introductorylanguage of the Current Procedural Terminology arthrodesis section. If neither decompression nor arthrodesis is performed, then an unlisted code for instrumentation placement alone would be appropriate. -Gregory J. Przybylski, MDEdison, N.J |