As the New Year is quickly approaching, it is time to explore the CPT® updates that can impact your neurosurgery practice. A coder knows that neurosurgery coding is complex and that it demands great attention for even the minutest of the details—even more now as we gear up for another challenging year. Here are some CPT® updates that will majorly affect the way you code for neurosurgery:
Imaging Guidance in Spinal Interlaminar Injections
The principles that guide interlaminar injection coding are:
- Anatomical localization of the injection in the spine.
- Use of imaging guidance for the procedure.
For interlaminar injections of therapeutic or diagnostic substances, you can choose form the following codes depending upon the spinal region where the injection is administered:
| 62320 | Injection(s), of therapeutic or diagnostic substance(s) (for example: anesthetic, opioid, steroid, antispasmodic, other solution), not including neurolytic substances, including catheter placement or needle, interlaminar epidural or subarachnoid, thoracic or cervical; without imaging guidance. |
| 62322 | Sacral (caudal) or lumbar; without imaging guidance. |
The codes for when the physician administers interlaminar injections using imaging guidance, are:
| 62321 | Injection(s), of therapeutic or diagnostic substance(s) (for example, anesthetic, opioid, steroid, antispasmodic, other solution), not including neurolytic substances, including catheter placement or needle, interlaminar epidural or subarachnoid, thoracic or cervical; with imaging guidance (fluoroscopy or CT). |
| 62323 | Sacral (caudal) or lumbar; with imaging guidance (fluoroscopy or CT). |
The codes for when the physician administers interlaminar therapeutic or diagnostic substance by continuous infusion or intermittent bolus, are:
| 62324 | Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of therapeutic or diagnostic substance(s) (for example anesthetic, opioid, steroid, antispasmodic, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, thoracic or cervical; without imaging guidance. |
| 62325 | Thoracic or cervical; with imaging guidance (fluoroscopy or CT). |
| 62326 | Sacral (caudal) or lumbar; without imaging guidance. |
| 62327 | With imaging guidance (fluoroscopy or CT). |
Prepare to Specify Location for Percutaneous Cryoablation of Nerves
CPT® 2017 will bring new codes for percutaneous cryoablation of peripheral nerves. The relevant code has to be selected by looking at the anatomical location of the cryoablation.
For nerves in the upper and lower extremities:
| 0440T | Ablation, percutaneous, cryoablation, includes imaging guidance; upper extremity distal/peripheral nerve. |
| 0441T | Ablation, percutaneous, cryoablation, includes imaging guidance; lower extremity distal/peripheral nerve. |
For percutaneous cryoablation of a plexus or nerves in the trunk:
| 0442T | Ablation, percutaneous, cryoablation, includes imaging guidance; nerve plexus or other truncal nerve (for example: brachial plexus, pudendal nerve). |
New Codes for Spinal Device Procedures
Below are some new codes that CPT® 2017 has also added for interspinous, intervertebral, and interlaminar biomechanical and stabilization spinal devices:
| 22853 | Insertion of interbody biochemical device(s) (synthetic cage, mesh) with integral anterior instrumentation for device anchoring (screws, flanges), when performed, to interverbal disc space in conjugation with interbody arthrodesis, each interspace. |
| 22854 | Insertion of intervertebral biochemical device(s) (synthetic cage, mesh) with integral anterior instrumentation for device anchoring (screws, flanges), when performed, to vertebral corpectomy(ies) (vertebral body resection, partial or complete) defect, in conjunction with interbody arthrodesis, each contiguous defect. |
| 22859 | Insertion of intervertebral biochemical device(s) (synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect. |
| 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. |
New Code for Endoscopic Decompression of the Lumbar Spine
With all these changes, CPT® 2017 will also include a new code for endoscopic decompression of the lumbar spine.
| 62380 | Endoscopic decompression of spinal cord, nerve root(s), including laminotomy, partial facetectomy, foraminotomy, discectomy and/or excision of herniated intervertebral disc, 1 interspace, lumbar). However, you should note that this code is inclusive of laminotomy, facetectomy, foraminotomy, and discectomy. |
For more insights on the CPT® changes that you might expect in 2017, attend this Webinar by expert speaker Gregory J. Przybylski, MD., who is a Professor of Neurosurgery at Seton Hall University and Interim Chairman of the NJ Neuroscience Institute at JFK Medical Center. You will also learn about the effective use of modifiers to obtain appropriate reimbursement for neurosurgical procedures.
Hello,
I have a question regarding the new codes 22867 and 22868. The description states per single level. If a physician is stating “Placement of biomechanical spacer device using Coflex implant at L5-S1 and L4-L5 with foraminotomies at L4, L5, and S1 would the coding be as follows:
22867
22868
63047-59