About 8-11 percent of people in the US suffer from lumbar spinal stenosis and it is expected that the disease will affect around 2.4 million Americans by 2021. The International Society for the Advancement of Spine Surgery (ISASS) recognizes decompression with interlaminar stabilization as a treatment option for lumbar spinal stenosis based on the patient’s pathology, surgeon’s expertise, and shared decision-making process. As medical coders in experienced medical coding companies know, interlaminar stabilization is reported with new CPT codes in 2017.
Lumbar spinal stenosis is characterized by narrowing of the spinal canal and neurogenic compression. Symptoms of the disease include pain or numbness in the legs and lower back. Progression of the disease can lead to spinal osteoarthritis and instability.
The two conventional options for treating spinal stenosis are: a simple decompression or decompression and spinal fusion. A simple decompression can temporarily relieve pain, but additional procedures including redecompression along with spinal fusion may be eventually needed. However, according to an article in Beckers ASC Review, moving to a fusion too quickly would limit range of motion and put the patient at risk for adjacent segment disease. Moreover, not all patients need aggressive treatment and may benefit from other solutions for stenosis management. While some may need a simple decompression, other may require fusion. Recent reports indicate that a large proportion of patients in the middle of these two extremes may be candidates for interlaminar stabilization.
An interspinous/interlaminar process stabilization/distraction device is placed between the spinous processes (the visible bones in the middle of the back). After insertion, the device is opened or expanded to open the neural foramen and decompress the nerves.
The ISASS Policy Statement published last year notes that “there exists a population of patients who present with moderate to severe stenosis, with concomitant back pain, where decompression alone does not adequately address back pain.” Interlaminar stabilization after direct decompression is a non-fusion surgical option that can provide the additional stability over decompression alone without the inflexibility of an instrumented fusion. The Policy states, “In select patients within the LSS continuum, decompression with interlaminar stabilization has proven to provide equivalent outcomes with a reduced cost compared to decompression plus fusion.’”
The 2017 CPT® codes additions to describe the insertion of an interlaminar/interspinous process stabilization/distraction device are:
- 22867: Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar, single level
- 22868: Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar, second level
- 22869: Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar, single level
- 22870: Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; second level
Points to note:
– These new CPT codes replace the 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.
– These CPT codes differ based on whether or not decompression was also performed.
– All four new codes 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
Interlaminar stabilization is being increasingly used by surgeons across the country, and medical billing outsourcing is helping them report services correctly for proper reimbursement. However, according the recent Beckers ASC Review report paraphrasing Hallett Mathews, MD, MBA, executive vice president and chief medical officer for Paradigm Spine, the patient’s safety and medical conditions must dictate the site of service over any financial considerations especially when spinal procedures are performed in the outpatient ASC.