Neurosurgery Coding Alert

Location and image guidance are key to coding for spinal interlaminar injections.

With the New Year fast approaching, it is time to explore the coding updates. The CPT^® reforms for 2017 introduce new codes that can impact your coding. Here is what lies in store for neurosurgery coders in 2017.

Do Not Forget Imaging Guidance in Spinal Interlaminar Injections

For interlaminar injections of diagnostic or therapeutic substances, you will choose form the following two codes depending upon the region of the spine where the injection is given:

• 62320, Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance
• 62322, …., lumbar or sacral (caudal); without imaging guidance.

If your physician administers the interlaminar injections using imaging guidance, you will choose from the following codes:

• 62321, Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (i.e., fluoroscopy or CT)
• 62323, …lumbar or sacral (caudal); with imaging guidance (i.e., fluoroscopy or CT)

“These codes maintain the CPT^® hierarchy of combining cervicothoracic procedures, which risk spinal cord injury, with lumbosacral injections which typically do not as well as differentiating the use of image guidance, which was separately reportable under prior coding rules,” says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison.  “The interlaminar injections allow performance without image guidance, in contrast to transforaminal injections which require image-guidance.”

When your physician administers the interlaminar diagnostic or therapeutic substance by continuous infusion or intermittent bolus, you will turn to the following codes:

• 62324, Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance
• 62325, …cervical or thoracic; with imaging guidance (i.e., fluoroscopy or CT)
• 62326, … lumbar or sacral (caudal); without imaging guidance
• 62327, …with imaging guidance (i.e., fluoroscopy or CT).

Tip: Two key principles guide your interlaminar injection coding: (i) anatomical localisation of the injection in the spine and (ii) use of imaging guidance for the procedure.

Prepare to Specify Location for Percutaneous Cryoablation of Nerves

CPT^® 2017 will introduce new codes for percutaneous cryoablation of peripheral nerves. You will select the relevant code by looking at the anatomical location of the cryoablation.

For nerves in the upper and lower extremities, you will submit codes 0440T (Ablation, percutaneous, cryoablation, includes imaging guidance; upper extremity distal/peripheral nerve) and 0441T (Ablation, percutaneous, cryoablation, includes imaging guidance; lower extremity distal/peripheral nerve), respectively.

For percutaneous cyroablation of a plexus or nerves in the trunk, you will submit code 0442T (Ablation, percutaneous, cryoablation, includes imaging guidance; nerve plexus or other truncal nerve [e.g., brachial plexus, pudendal nerve]). “These code maintain the typical CPT^® organization which differentiate limb treatments from torso treatments,” Przybylski says.

Spot These New Codes for Spinal Device Procedures

CPT^® 2017 will bring new codes for intervertebral, interspinous and interlaminar biomechanical and stabilization spinal devices. These new codes are listed in table 1.

Here is another new code: CPT^® 2017 will also include a new code for endoscopic decompression of the lumbar spine: 62380 (Endoscopic decompression of spinal cord, nerve root[s], including laminotomy, partial facetectomy, foraminotomy, discectomy and/or excision of herniated intervertebral disc, 1 interspace, lumbar). Note that this code is inclusive of laminotomy, facetectomy, foraminotomy, and discectomy. “Previously, endoscopic decompressions were correctly reported with an unlisted procedure code,” Przybylski says. “This new descriptor differentiates percutaneous discectomy reported with CPT^® 62287 from the additional work included in the endoscopic discectomy that involves the partial bony removal of lamina, facet and pars interarticularis.”