Neurosurgery Coding Alert

Graft and instrumentation descriptors gain new language CPT 2008 will bring relatively few changes directed specifically at neurosurgery practice, but among them are three exciting new codes for spinal osteotomy procedures. These new osteotomy codes include: - 22206 -- Osteotomy of spine, posterior or posterolateral approach, three columns, one vertebral segment (e.g., pedicle/vertebral body subtraction); thoracic - 22207 -- - lumbar - +22208 -- - each additional vertebral segment (list separately in addition to code for primary procedure). A parenthetical reference accompanying the codes in CPT specifies that you-ll use these codes for "pedicle/vertebral body subtraction" -- which surgeons may also refer to as "transpedicular three-column osteotomy." As outlined in the code descriptors, 22206-22208 all include either posterior or posterolateral approach and involve three columns (the lamina with pedicles/facets, the posterior vertebral body, and the anterior vertebral body) within one vertebral segment. Previously, CPT did not contain a code to describe these procedures. Although these procedures are not commonly done, surgeons and coders really needed a method to account for these complex and lengthy procedures. Surgeons perform osteotomy of this type most commonly to treat fixed sagittal imbalance (also known as "flat back"), which is itself often related to previous spinal surgery or severe degenerative disc disease with loss of lordosis.-Spinal deformity with straightening or kyphosis causes the patient to lean forward, with the center of gravity in front of the sacrum, resulting in poor posture, pain, difficulty walking and other problems. Essentially, pedicle/vertebral body subtraction removes posterior bone to increase the forward curvature of the mid-spine (lordosis), so people who are normally hunched over can stand up straighter, says Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University department of surgery. "This is also what differentiates pedicle/vertebral body subtraction from the other posterior spinal osteotomy codes," he adds. How you-ll use the codes: Most neurosurgery coders will find the format of 22206-22208 familiar and easy to apply. For the first vertebral segment the surgeon treats via either posterior or posterolateral approach for osteotomy of the spine in the thoracic region, you-ll report 22206. Similarly, for the first vertebral segment the surgeon treats via either posterior or posterolateral approach for osteotomy of the spine in the lumbar region, you-ll report 22207. The nature of the surgery precludes the surgeon from treating the cervical spine, which is why there is no such code, Sandhusen says. You-ll report only a single unit of either 22206 or 22207 per operative session. For each segment the surgeon treats beyond the first, whether thoracic or lumbar, you-ll report one unit of 22208. Because 22208 is an add-on code, you would never report it alone, but only with 22206 or 22207. Example: The surgeon [...]