New Spinal Cage Codes – 2017

Question:

I see that CPT code +22851, Application of intervertebral biomechanical device(s) to vertebral defect or interspace was deleted effective 1/1/17. What code do I now use?

Answer:

Three codes have been added to CPT 2017 to replace +22851:

• +22853 is used for a device, with fusion, with or without integrated anterior fixation
• +22854 is used for a device to fill a corpectomy defect, with fusion, with or without integrated anterior fixation
• +22859 is used for interbody device insertion without fusion

Note that +22853 and +22854 include the integral anterior instrumentation for device anchoring when that type of device is used. If you do not use integrated fixation, it is still the same codes, +22853 or +22854. If you use a separate plate, you may separately report a code such as +22845 when the plate meets the code criteria (e.g., the plate crosses the interspace, can provide independent stabilization, and can be used with any other type of interspace device).

*This response is based on the best information available as of 01/05/17.

Reduction of Spondylolisthesis

Question:

It was recently brought to my attention that there is a code for spondylolisthesis reduction (22325, Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; lumbar). I do many procedures in which I reduce spondylolisthesis. In fact, I did two yesterday. Can I use 22325 in addition to 63047 on these procedures?

Answer:

Actually, the open fracture treatment codes (22325-22328) are intended for reduction/repair of traumatic fractures. For treatment of spondylolisthesis, it is best to use a code from the 630xx series of CPT such as 63047 or even 63012. It is not accurate to report a fracture treatment code (22325) with a decompression code (63047) for a procedure at the same spinal level.

*This response is based on the best information available as of 03/17/16.

Harvest of Abdominal Fat Graft

Question:

My doctor harvested abdominal fat that he then used in the nose to close the area when he did an endoscopic removal of a pituitary tumor (62165). I want to bill 15770, but my doctor thinks the correct code is 20926. What do you recommend?

Answer:

Your doctor is correct with 20926 (Tissue grafts, other (e.g., paratenon, fat, dermis)). CPT 15770 (Graft; derma-fat-fascia) is used for a composite graft when more than one layer of tissue is harvested and placed (e.g., fat and fascia). When only one layer of tissue is harvested, such as fat, report 20926.

*This response is based on the best information available as of 12/17/15.

Removal of Spinal Cord Stimulator

Question:

My doc removed an electrode plate previously placed via laminectomy – 63662. At the same time, he removed the pulse generator – 63688. Is the removal of the generator considered a secondary procedure and therefore reduced in reimbursement by 50%?

Answer:

Yes, that’s correct. CPT 63662 is the higher valued code so it should be paid at 100% of the payer allowable. The generator removal, 63688, is the lower valued code and CPT says to report it with modifier 51 (multiple procedures).

Therefore, 63688 will typically be reduced by the payer’s multiple procedure payment formula (MPPF). Medicare’s MPPF is 50% for secondary stand-alone procedures.

*This response is based on the best information available as of 12/03/15.

63005 vs. 63047

Question:

Help me understand the difference between 63005 and 63047 – I don’t get it! The codes look the same to me.

Answer:

Yes, it can be confusing because the code descriptions are very similar. However, look very carefully and you’ll see the differences. Here are the code descriptions and I’ve bolded some key differences:

CPT Code	Description
63005	Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy, (e.g., spinal stenosis), one or two vertebral segments; lumbar, except for spondylolisthesis
63047	Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s), (e.g., spinal or lateral recess stenosis)), single vertebral segment; lumbar

CPT 63005 is generally used for removal of the lamina to provide central decompression of the spinal cord. CPT 63047 involves not only removal of lamina for central decompression but also lateral recess decompression in the form of a facetectomy (e.g., medial, partial) and/or foraminotomy for nerve root decompression.

*This response is based on the best information available as of 08/27/15.

ICD-10: Procedural Coding System vs. CPT Codes

Question:

Now that ICD-10 is going to happen I’m starting to look into it a bit more. I see there is a procedural coding system component. Are we going to have to use that instead of, or in addition to, CPT?

Answer:

Good Question:. The ICD-10 procedural coding system (ICD-10-PCS) is used by facilities (e.g., hospital) to code procedures. CPT codes are, and will continue to be, used by physicians (and other providers) to report professional services. The two systems are unique and very different. You will not be using ICD-10-PCS to report professional services; rather, you will continue to use CPT codes. You will, however, be changing from ICD-9-CM (ICD-9 Clinical Modification) diagnosis codes to ICD-10-CM diagnosis codes on October 1, 2015 for claims submitted to HIPAA-covered entities. So the good news is that the CPT coding system is not changing for physicians – only the diagnosis coding system will be different.

*This response is based on the best information available as of 04/23/15.