Neurology & Pain Management Coding Alert

Pay attention to arthrocentesis and kyphoplasty/vertebroplasty guidelines. 

CMS has published its list of CCI Manual updates, and several apply to physicians who perform arthrocentesis or vertebroplasty. Read on for the rundown and where you can find more information. 

Clarification 1: CPT® codes 20600-20611 (Arthrocentesis, aspiration and/or injection ...) represent aspiration and/or injection to different sized joints or bursae with or without ultrasound guidance. When reporting these codes, remember that a unit of service equals a joint and its surrounding bursae (if any). Do not report more than one unit of service for arthrocentesis of any joint, regardless of whether the physician also aspirates or injects one or more of the bursae surrounding the joint. 

Example: Your physician performs arthrocentesis of the shoulder and two bursae of the same shoulder. He uses ultrasound guidance. You should report one unit of 20611 (Arthrocentesis, aspiration and/or injection, major joint or bursa [e.g., shoulder, hip, knee, subacromial bursa]; with ultrasound guidance, with permanent recording and reporting).  

Clarification 2: Codes 22510-22512 (Percutaneous vertebroplasty [bone biopsy included when performed], 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance ...) represent percutaneous vertebroplasty to different spinal areas. Similarly, codes 22513-22515 (Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device [e.g., kyphoplasty], 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance ...) describe kyphoplasty to specific spinal locations. When reporting either of these procedures, you should only submit one primary procedure code (such as 22510 or 22513) and the add-on code for the procedure (+22512 or +22515) for each additional level, whether the additional level(s) are contiguous or not.  

Example: T12 and L1 percutaneous vertebroplasty would be reported with 22510 and the add-on code, 22512, each with one unit of service. The vertebroplasty should not be billed as 22510 and 22511 as two primary procedure codes.

Clarification 3: Medicare payment for programmable pump analysis, reprogramming, and refill includes the refill kit. Therefore, do not submit HCPCS code A4220 (Refill kit for implantable infusion pump) separately with CPT® codes 62369 (Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion [includes evaluation of reservoir status, alarm status, drug prescription status]; with reprogramming and refill) or 62370 (... with reprogramming and refill [requiring skill of a physician or other qualified health care professional]).

Learn more: To see the complete manual, log on to:  http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html.