Augmentation of Pedicle Screws

Question:

I injected cement into the pedicles to augment screws in a patient with osteoporosis. My coder suggested using +22859 (Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)) for this procedure but that didn’t seem right to me. What is your advice?

Answer:

We agree with you that +22859 is not accurate. Augmentation of pedicle screws is not separately reported as it is included in the posterior instrumentation code (e.g., +22840, +22842) when performed.

*This response is based on the best information available as of 10/31/19.

T9-11 Epidural Tumor Removal

Question:

I did bilateral laminectomies at T9, T10, T11 and removed an epidural tumor. I billed 63276-50, 63276-50-59 and 63276-50-59 but got paid for only 63276-50. Should I have used modifier XS (separate site) instead of 59?

Answer:

CPT 63276 (Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, thoracic) involves removal of the tumor and included any, and all, levels of laminectomy required for access and tumor removal. Also, the code also implies both sides of the lamina were removed. Therefore, in your situation, only 63276 alone should have been reported.

*This response is based on the best information available as of 10/17/19.

Artificial Cervical Disc Placement

Question:

We are just starting to do these procedures and I want to get our coding sorted out. We will be doing a cervical discectomy with decompression under fluoroscopy and implanting the artificial disc. We think the correct codes are: 22551(anterior cervical discectomy and decompression), 22856 (total disc arthroplasty) and 76000 (fluoroscopy). Are we right?

Answer:

How exciting to add a new procedure to the practice! And, kudos for being proactive about the coding. Actually, CPT 22856 includes the discectomy, decompression and placement of the implant. Additionally, it would not be accurate to separately report 22551 because an arthrodesis (also included in 22551) is not performed in this procedure. Lastly, fluoroscopy (76000) is included in all open spine surgical procedure codes and not separately reported. Therefore, 22856 covers the entire procedure for a one-level total disc arthroplasty. CPT +22858 would be used for the second level if performed.

22856 Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); single interspace, cervical

*This response is based on the best information available as of 10/03/19.

DBS Battery Replacement

Question:

When our doctors replace a DBS generator because the battery is depleted and they reprogram at the same time, we can bill for the programming, correct?

Answer:

Yes, you can code for the generator replacement using 61885 (or 61886 if the two leads – right and left – are connected to one battery).  You can also code 95983 if the reprogramming is truly performed by the surgeon (and not a company rep) and the parameters programmed to are documented (e.g., amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation).  The surgeon must do the programming him/herself – not the vendor rep – and document the actual parameters in order for the neurosurgeon to bill for the programming.

Note that the DBS programming codes changed in 2019.  The old codes, 95978 and +95979, were deleted. The new codes are:

95983

Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain neurostimulator pulse generator/transmitter programming, first 15 minutes face-to-face time with physician or other qualified health care professional

+95984

with brain neurostimulator pulse generator/transmitter programming, each additional 15 minutes face-to-face time with physician or other qualified health care professional (List separately in addition to code for primary procedure)

The old codes were for a time frame of an hour whereas the new codes are now in 15 minute increments.

*This response is based on the best information available as of 07/25/19.

Coding for Platelet-Rich Plasma Injections in the Spine

Question:

We are starting to do platelet-rich plasma injections in the spine.  Would we bill 64483?

Answer:

No because 64483 is specifically for an “anesthetic agent and/or steroid” injection.  The most accurate code is 0232T (Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed).  Be sure to obtain prior authorization as this service is oftentimes not covered.

*This response is based on the best information available as of 5/23/19.

63042

Question:

When would I ever use 63042?  I am not sure I understand the meaning of this code.

Answer:

Good Question:!  CPT 63042 (Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar) is used when the diagnosis is recurrent herniated disc and a re-do discectomy is performed outside the post-operative global period of the initial discectomy.  It doesn’t matter if you did the original discectomy or another surgeon.  The point is that the patient has had a prior discectomy at that same spinal level more than 90 days (the post-operative global period of the lumbar discectomy code, 63030).  Be sure to document the fact that the patient had prior surgery, and when, at that specific level.

*This response is based on the best information available as of 4/25/19.