Spine surgeons face a multitude of Current Procedural Terminology ® (CPT) code changes, effective Jan. 1, 2017. This article provides a summary of these changes so practices can get a head start on understanding their implications. A complete listing of changes can be found in the 2017 CPT manual.
Approach and visualization definitions
The Spine and Spinal Cord section of the Nervous System codes in CPT 2017 provides new definitions of key terms and surgical approaches to further clarify these CPT code descriptors, as shown in Table 1.
Surgical CPT codes are presumed to be open unless the code descriptor states otherwise.
One of the key coding changes for spine surgeons is the deletion of CPT code +22851, previously defined as "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)."
Data from the Centers for Medicare & Medicaid Services (CMS) identified +22851 as a "fastest growing procedure" in 2008 and then as a "high expenditure procedure" in 2011, reflecting the increased use of these devices. More importantly, survey data showed that +22851 was not always accurately used, which likely contributed to the utilization increase.
Three new CPT codes have been created for 2017 to replace the deleted code. Table 2 shows each of the three new codes with its corresponding descriptor and comments about how each code is to be used.
Like +22851, the new codes are add-on codes and are never appended with modifier 51 (multiple procedures). Several instructional and add-on code parenthetical notes have been added to the CPT manual to clarify the deletion of +22851 and the addition of these new codes.
Closed treatment of vertebral process fracture
CPT 22305 (Closed treatment of vertebral process fracture[s]) will be deleted due to low utilization. Providers are instructed to use an evaluation and management (E/M) code instead.
Posterior spinous process device
Table 3 shows the four new codes established to describe the insertion of an interlaminar/interspinous process stabilization/distraction device. The codes are differentiated based on whether or not decompression was also performed. These codes will 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.
All four new codes include any imaging guidance (such as fluoroscopy) required to insert the device. Additionally, none of these codes may be reported with other spine procedures codes, including specific arthrodesis, instrumentation, and decompression codes.
Interlaminar epidural or subarachnoid injections
Codes 62310 and 62311 will be deleted and each will be replaced with two new codes to describe the procedures being performed (Table 4). The new codes are assigned based on whether imaging guidance is used. CMS identified the deleted codes as "potential misvalued," citing data showing that the services were typically performed with imaging guidance.
A similar change applies to codes 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. Both 62318 and 62319 will be deleted. New codes for cervical or thoracic injections—62324 (without imaging guidance) and 62325 (with imaging guidance—as well as for lumbar or sacral injections—62326 (without imaging guidance) and 62327 (with imaging guidance)—are being introduced.
A new lumbar endoscopic decompression 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)—is being added. This code may be reported with modifier 50 when a bilateral procedure is performed.
As a result of this new code addition, code 62287, the percutaneous intervertebral disk decompression code, is being revised to remove the words "with the use of an endoscope."
The Category III codes 0274T and 0275T, for a percutaneous decompressive laminotomy/laminectomy (interlaminar approach), are also being revised to remove the words "with or without the use of an endoscope," in accordance with the new definitions of surgical approaches previously discussed.
Fluoroscopy with muscle biopsy
The guideline for code 20206 (Biopsy, muscle, percutaneous needle) now says that code 77002 (Fluoroscopic guidance for needle placement [eg, biopsy, aspiration, injection, localization device]) may be separately reported, beginning in 2017.
Open bone biopsy codes
Although not solely used by spine surgeons, the open bone biopsy codes 20240 and 20245 are being revised to provide further differentiation between the two codes. This should be helpful in reporting more accurate coding. Table 5 shows the codes, the 2016 and 2017 descriptors, as well as a brief summary of the code changes.
Within the musculoskeletal section of CPT, additional changes will affect foot and ankle codes; these will be addressed in a future edition of AAOS Now.
Kim Pollock, RN, MBA, CPC, CMDP, is a consultant with KarenZupko & Associates, Inc., who focuses on coding and reimbursement issues in spine surgery practices. Information in this article has been reviewed by members of the AAOS Coding, Coverage, and Reimbursement Committee.