Neurosurgery Coding Alert

Watch out: Overlooking these neurosurgery revisions could cost you big in 2009.

When your neurosurgeon handles total disc arthroplasties, you have reason to rejoice. CPT Upgrade Category III codes 0090T, 0093T, and 0096T to regular Category I codes--and it's up to you to apply them as of Jan. 1.

Best advice: "I always recommend my offices review the information as early as possible -- before the implementation date, so they can be aware of changes impacting their practice," says Regina H. Tinney, CPC, coding specialist at  Crossroads Healthcare Management in College Station, Texas.

First of all, you-ve got an arthroplasty shift from carrier-priced Category III codes to regular national-valued CPT Codes , and that shift shows the procedures have gained more industry acceptance. Until recently the data lagged behind to create  Category I codes for cervical total disc arthroplasty, explained 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.

2008 way: For cervical artificial intervertebral disc procedures, you have the following Category III codes to use:

- 0090T --" Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression) cervical; single interspace

- +0092T --" - each additional interspace (List separately in addition to code for primary procedure)

- 0093T --" Removal of total disc arthroplasty, anterior approach cervical; single interspace

- +0095T --" - each additional interspace (List separately in addition to code for primary procedure)

- 0096T --" Revision of total disc arthroplasty, anterior approach cervical; single interspace

- +0098T --" - each additional interspace (List separately in addition to code for primary procedure).

2009 way: CPT deletes codes 0090T, 0093T, and 0096T. Instead, you-ll report these three regular (Category I) cervical disc replacement codes:

- 22856 --" Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdis- section), single interspace, cervical

- 22861 --" Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical

- 22864 --" Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical.

Example: Your physician sees a 45-year-old man with persistent neck pain and C6 radiculopathy for six months who is unresponsive to non-operative treatments. The patient undergoes a C6 anterior cervical total disc arthroplasty to treat a single-level spondylotic disc causing nerve compression. The surgeon performs an anterior approach for placement of the artificial disc after decompressing the nerve with an osteophytectomy, as well as preparing the end plates for placement of the artificial disc device. You should report 22856.

Be careful: Be cautious about 22856, which includes the term "decompression." Why: You should consider the decompression performed at the interspace where the physician is placing the artificial disc as an inclusive part of the procedure. In other words, you should not report it separately. "Decompression codes are difficult to apply to dictated reports," warns Pat Tietz, CPC, coder for The Twin Cities Spine Center in Minneapolis. Also, remember "your physician needs to qualify the -segment.-"

Many coders are hopeful this will change how payers view these procedures. "The transition to regular codes" at least suggests "insurance payers may pay for the total disc arthroplasty more easily," says Lori Montanez, CPC, coder at Spine Orthopaedic & Rehabilitation Center (SORC) in Albuquerque, N.M. "Many payers said, due to the Category III code, their system automatically denied it for -procedure experimental.-"

Other experts are dubious. "I am glad CPT changed these services into regular CPT codes; it's a step in the right direction --" but unfortunately this doesn't mean insurers will reimburse for them," Tinney warns.

For instance, Blue Cross of Idaho already lists these new codes in its "Antevertebral Disc: Cervical Spine" Medical Policy (http://www.bcidaho.com/providers/medical_policies/sur/mp_701108.asp). The policy, however, continues to state, "Artificial intervertebral discs are considered investigational for treatment of disorders of the cervical spine, including degenerative disc disease."

To account for the new arthroplasty codes, several related existing CPT codes have had minor editorial revisions.

For instance, 22857 now states, "Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), single interspace, lumbar" (emphasis added). Terms "single interspace" and "lumbar" swapped to match up with two other revisions.

Code 22862 states only, " - lumbar" to pair with 22861. Similarly, 22865 states only " - lumbar" to pair with 22864.

What this means: You need to be sure you know where your physician is performing the total disc arthroplasty procedure. If they occur in a lumbar area, you may use the above codes.