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Neurosurgery Coding Alert

2005 Fee Schedule Update:

Count on Decent Laminoplasty, Reduced Vertebroplasty Fees

Published on Sat Jan 22, 2005

Along with a 1.5 percent across-the-board payment increase, the 2005 Physician fee schedule will bring higher-than-anticipated reimbursement for several new laminoplasty codes. (See "Physician Payments Rise in 2005," Neurosurgery Coding Alert, January 2005 for more on how the fee schedule will affect your practice.)
 
The bad news: While giving with one hand, the fee schedule takes away with the other, significantly reducing payments for several established procedures, including, most notably, percutaneous vertebroplasty.

Open Door = Greater Reimbursement

Neurosurgery practices cheered the arrival of two new codes to describe so-called "open door" laminoplasty this year, and now they have reason to cheer once again now that CMS has announced the relative value units (RVUs) for these procedures.
 
The new laminoplasty codes, which CPT introduced effective Jan. 1, 2005, are:

  • 63050 - Laminoplasty, cervical, with decompression of the spinal cord, two or more vertebral segments
  • 63051 - Laminoplasty, cervical, with decompression of the spinal cord, two or more vertebral segments; with reconstruction of the posterior bony elements (including the application of bridging bone graft and non-segmental fixation devices [e.g., wire, suture, mini-plates], when performed).

    Medicare assigned 37.23 nonfacility RVUs to 63050, totaling payment of about $1,410, and assigned 42.36 non-facility RVUs to 63051, giving it a base rate of about $1,605.
     
    These new codes "involve procedures which leave portions of the posterior elements intact," unlike the existing posterior decompression codes 63015 (Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy [e.g., spinal stenosis], more than 2 vertebral segments; cervical) and 63001 (Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy [e.g., spinal stenosis], one or two vertebral segments; cervical), which involve complete removal of the posterior spinal elements, according to the AMA's CPT Changes 2005: An Insider's View.

    CMS Recognizes the Complexity of Laminoplasty

    The new RVUs demonstrate the complexity of the "open-door" laminoplasty that the new codes describe.
     
    "Code 63015 only pays about $1,357, and 63001 pays about $1,098, so Medicare clearly understood the additional difficulty that goes into the open-door laminoplasty," says Heather Corcoran, coding manager at CGH Billing Services in Louisville, Ky.

    Expect Pay Drop for 22520

    Unfortunately, Medicare also slashed RVUs for several surgical procedures this year. Even the higher conversion factor won't change the fact that you'll lose money for some commonly performed procedures.
     
    Example: In 2004, Medicare paid $4,171 for percutaneous vertebroplasty (22520, Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic) (111.71 RVUs times 37.3374).
     
    In 2005, however, that will drop to $2,728 (71.98 RVUs times 37.8975) - a 35 percent cut in reimbursement.
     
    "Medicare will also be cutting the lumbar version of this procedure (22521) by 32 percent," says Randall Karpf, owner of East Billing in Hartford, Conn. "Clearly, Medicare thought that these vertebroplasty procedures were vastly overvalued. Unfortunately, this is really going to hurt spine surgeons who specialize in percutaneous vertebroplasty."

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