Neurosurgery Coding Alert

These notes bundle 4 services.

You-ll have a streamlined way to report cervical disc replacement in 2009.

Spine surgery is currently reported with four different codes representing each surgical step. There's a trend to create bundles "that include the approach, discectomy, insertion and decompression," said Charles Mick, MD, a Northampton,  Mass.-based Pioneer Spine and Sports physician in "Spine Surgery/Neurosurgery" at the CPT and RBRVS 2009 Annual Symposium in Chicago.

Therefore, 22856's note indicates to not report this code in conjunction with: "22554 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression]; cervical below C2), +22845  (Anterior instrumentation; 2 to 3 vertebral segments ... ), +22851 (Application of intervertebral biomechanical device[s] [e.g., synthetic cage(s), threaded bone dowel(s), methylmethacrylate] to vertebral defect or interspace ... ), or 63075 (Discectomy, anterior, with decompression of spinal cord and/or nerve root[s], including osteophytectomy; cervical, single interspace) when performed at the same level (interspace)." Also, "do not report 22856 in conjunction with +69990  (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure])."

Catch this: Code 22856 is approved for only one level, Mick reports. For any additional interspace(s) in which the physician performs any cervical total disc arthroplasty, use +0092T.

For taking out a disc and putting a new one in, you-ll use 22861. This code's note specifies, "Do not report this code in conjuction with +22845, +22851, 22864, or 63075 when performed at the same level. Do not report 22861code in conjunction with +69990."

For instance, a 48-year-old male presents post anterior cervical disc arthroplasty. Follow up x-rays show migration of the implant requiring revision. For removing the disc and implanting the new device, you-d use one code for the entire approach, Mick explains.

Once again, for "an additional level, you-d use the Category III code (+0098T)," Mick says.

You-ll find similar language under 22864: Do not report this code in conjunction with 22861, +69990. For additional interspace(s) in which the physician performs a revision of cervical total disc arthroplasty, use +0095T.

You will likely see the next round of Correct Coding Initiative (CCI) edits reflecting these notations. Check back with the Neurosurgery Coding Alert for the latest information.