Neurosurgery Coding Alert

With no dedicated new code, you'll have to stick with S2362/S2363 or 22899

Neurosurgery practices hoping for a dedicated CPT code to describe kyphoplasty will have to continue waiting: The AMA has not approved the hoped-for and much-rumored code in time for CPT 2005.

Instead, you will have to continue to report either S2362 (Kyphoplasty, one vertebral body, unilateral or bilateral injection) and S2363 (... each additional vertebral body [list separately in addition to code for primary procedure]) or 22899 (Unlisted procedure, spine) for kyphoplasty, depending on the payer, says Heidi Stout, CPC, CCS-P, coding and reimbursement manager at UMDNJ-RWJ University Orthopaedic Group in New Brunswick, N.J.

HCPCS 2004 introduced S2362 and S2363, but Medicare did not assign any relative value units (RVUs) to the codes. Therefore, you should report these codes only to private payers that recognize them: If you're reporting kyphoplasty to Medicare, you should continue to use the code for unlisted spine procedures (22899).

You should report one unit of 22899 for each spinal level attended. Most payers consider 22899 all-inclusive and deny additional claims for fluoroscopy, injections and any other procedures the neurosurgeon provides during the kyphoplasty. The surgeon, however, should indicate if and when these procedures are included with kyphoplasty.

Regional Medicare carriers maintain policies toward kyphoplasty, but guidelines vary widely. For example, the California Medicare carrier's (NHIC) policy states that kyphoplasty coverage does not include any follow-up days - meaning that you should report all pre- and postoperative visits separately. Some commercial payers consider the procedure investigational and therefore do not cover kyphoplasty.

TrailBlazer LLC (the Part B carrier for the District of Columbia metropolitan area) requires practices to list a description of the procedure on the CMS-1500 claim form, "or the words 'balloon-assisted percutaneous vertebroplasty' in the 'comments' section of the electronic claim form." You should also specify the spinal level(s) the surgeon treated.

Other carriers, in contrast, require only that you include a copy of the operative report along with the claim.