Spine surgery is one of the most common procedures performed by spinal orthopedists and neurosurgeons. In 2017, these specialists and the medical billing and coding companies that serve them are facing several CPT codes changes. Understanding these changes and their implications, and being prepared to implement them is crucial for spine specialists to optimize reimbursement.
Key Approach and Visualization Definition Changes for Spine Surgery Practices
To select the correct spinal CPT® code based on approach, it is important to be aware of the new definitions applicable to approach and type of visualization for spine procedures in 2017:
|Approach||Type of Visualization|
|Percutaneous||Image-guided procedures (such as CT or uoroscopy) performed with indirect visualization of the spine without the use of any device that allows visualization through a surgical incision|
|Endoscopic||Continuous direct visualization through an endoscope|
|Open||Continuous direct visualization through a surgical opening|
|Indirect||Image-guided (such as CT or uoroscopy); not light-based visualization|
|Direct||Light-based visualization; can be performed by eye or with surgical loupes, microscope, or endoscope|
New Spine Surgery CPT Codes and Deletions
- Code +22851 deleted
One key change for spine surgeons is the deletion of code +22851 (application of intervertebral biomechanical device(s) (eg, synthetic cage(s), methyl methacrylate) to vertebral defect or interspace (List separately in addition to code for primary procedure). The issues with this code were:
- The American Association of Orthopaedic Surgeons (AAOS) says that survey data shows that +22851 was not always correctly used, which likely contributed to increased use of these devices
- It did not adequately describe the levels of complexity in insertion of biomechanical devices with spine surgery
- Replacement codes for +22851
The following table shows the three new codes that replace the deleted code, their corresponding descriptors and AAOS’ guidelines on how each code should be used:
+22853 Insertion of interbody biomechanical device(s), such as synthetic cage or mesh, into intervertebral disc space in conjunction with interbody arthrodesis Code per each treated intevertebral disk space, e.g., PEEK device, low-profile orintegrated device placed in an interspace for arthrodesis +22854 Insertion of intevertebral biomechanical device(s) with integral enterior instrumentation for device anchoring when performed, to vertebral corpectomy(ies), in conjunction with interbody arthrodesis, each contiguous defect Code per each contiguous corpectomy defect when arthrodesis is also present, e.g., PEEK device, expandable cage, low-profile/integrated device placed into a corpectomy defect for arthrodesis +22859 Insertion of interbody biomechanical device(s) when performed without interbody arthrodesis Code for each contiguous disk space/corpectomy defect when there is no arthrodesis, e.g., spinal reconstruction with prosthetic placement of resected vertebral body without placement of bone graft
These new codes are add-on codes and not to be appended with modifier 51 (multiple procedures).
- Code 22305 deleted
Code 22305, closed treatment of vertebral process fracture(s), a bony projection on the back of a vertebra, one of the interlocking bones of the spine. An appropriate evaluation and management (E/M) code should be used to report this service.
- Four new codes for insertion of posterior spinous process device
New codes (22867-22870)describe the insertion of an interlaminar/interspinous process stabilization/distraction device. The codes are distinguished based on whether or not decompression was also performed.
Codes 22867-22870 replace two deleted Category III codes 0171T, insertion of posterior spinous process distraction device [including necessary removal of bone or ligament for insertion and imaging guidance], lumbar; single level) and 0172T, the associated add-on code for each additional level.
Points to note
- 22867-22870 include any imaging guidance (such as fluoroscopy) required to insert the device
- None of these codes should be reported with other spine procedures codes, including specific arthrodesis, instrumentation, and decompression codes
- Four new codes for Interlaminar epidural or subarachnoid injections
Codes 62310 and 62311 have been deleted and each is replaced with two new codes to describe the procedures being performed. So there are four new codes for epidural and subarachnoid injections: 62321, 62323, 62325, and 62327. These new codesare assigned based on whether imaging guidance is used.
- New codes for cervical or thoracic injections
Cervical or thoracic injections have 2 new codes:
62324 (without imaging guidance)
62325 (with imaging guidance)
The two new codes for lumbar or sacral injections are:
62326 (without imaging guidance) and
62327 (with imaging guidance)
Two codes have been deleted: 62318 (cervical or thoracic) and 62319 (lumbar or sacral), which described the injection as including indwelling catheter placement with continuous infusion or intermittent bolus codes.
- Other Changes
- Code 62380, Endoscopic decompression of spinal cord, nerve root[s], including laminotomy, partial facetectomy, foraminotomy, diskectomy and/or excision of herniated intervertebral disk, 1 interspace, lumbar (may be reported with modifier 50 when a bilateral procedure is performed)
- Code 62287, Percutaneous intervertebral disk decompression, has been revised to remove the words “with the use of an endoscope”
- Category III codes 0274T and 0275T, for a percutaneous decompressive laminotomy/laminectomy (interlaminar approach), have also been revised to remove the words “with or without the use of an endoscope
- Starting 2017, the guidelines for code 20206 (Biopsy, muscle, percutaneous needle) says that code 77002 (Fluoroscopic guidance for needle placement [eg, biopsy, aspiration, injection, localization device]) may be separately reported
- Open bone biopsy codes 20240 and 20245 have been revised further differentiate between the two codes
Outsourcing medical billing can help orthopedic surgeons select the right codes and utilize them correctly to prevent improper billing and denials.