Neurosurgery Coding Alert

Here’s what you should report instead of +0163T in 2023.

The AMA has set its additions, revisions, and deletions for the CPT^® 2023 coding book … and there is a little bit of everything for neurosurgery coders.

Check it out: Some of the changes involve the usual tweaks to verbiage or syntax; there are also, however, some pretty important additions, revisions, and deletions to currently existing code sets.

Here’s what you’ll need to focus on to get ready for CPT^® 2023, which will go into effect on Jan. 1, 2023.

Suture Removal Gets Reworked

CPT^® 2023 will revise a section of the code book dealing with suture/staple removal. Here’s a look at how this section of the manual will look next year (On “Revised” codes, strikethroughs denote what’s being deleted from 2022 definitions; underlines denote what’s being added for 2023 definitions):

Deleted:

• 15850 (Removal of sutures under anesthesia (other than local), same surgeon)

Revised:

• 15851 (Removal of sutures or staples under requiring anesthesia (ie, general anesthesia, moderate sedation)(other than local), other surgeon)

Added:

• +15853 (Removal of sutures or staples not requiring anesthesia (List separately in addition to E/M code))
• +15854 (Removal of sutures and staples not requiring anesthesia (List separately in addition to E/M code))

Impact: CPT^® is getting rid of 15850 and instructing coders to use 15851 instead. The revised 15851 code is more detailed, adding “or staples” to the descriptor, as well as making the verbiage clearer with regards to the types of anesthesia. Further, the code descriptor drops the requirements “other than local” and “other surgeon.”

The new add-on codes in the suture/staple removal category, +15853 and +15854, appear identical, and they are — nearly. The only difference between the two codes is that +15853 is for removal of sutures or staples; +15854 is for removal of sutures and staples. Both are performed without general anesthesia or moderate sedation, and therefore may include local anesthesia.

Also, the instructions for these codes require you to append them to an evaluation and management (E/M) code — not procedure codes. So, let’s say the physician performs a level-three office E/M service for an established patient and then removes sutures and staples without anesthesia. In 2023, you’ll report 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.) with +15854 appended for the service.

Arthroplasty Code Gets New Add-on

CPT^® 2023 will also tweak a couple of arthroplasty codes and an arthrodesis code. Here’s a look at how this section of the manual will look next year (On “Revised” codes, strikethroughs denote what’s being deleted from 2022 definition; underlines denote what’s being added for 2023 definitions):

Revised:

• 22857 (Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression),; single interspace, lumbar)
• 27280 (Arthrodesis, open, sacroiliac joint, open, includingincludes obtaining bone graft, including instrumentation, when performed).

New:

• +22860 (… second interspace, lumbar (List separately in addition to code for primary procedure))

Impact: The revisions to 22857 and 27280 are more about tightening up the language in the descriptors than changing anything substantial. Although no official guidance has been issued yet, it looks like you’ll report +22860 if you need to code for a second interspace beyond the first represented by 22857.

“It has been nearly two decades since the results of two-level lumbar disc arthroplasty have been reported on in the spine literature,” explains Gregory Przybylski, MD, Immediate Past Chairman of Neuroscience and Director of Neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey. “FDA approval was finally given in 2020 for two adjacent level-artificial lumbar disc replacement (between L3 and S1), prompting the change for the additional level procedure from a category III code to a category I code. The FDA [Food and Drug Administration] has not approved cervical or lumbar disc replacement at three or more levels.”

CPT^® Alters Implant Revisions, Removals, Replacements

In 2023, your code book will also contain revisions and new codes for coding revisions, replacements, and removals of osseointegrated skull implants. Here’s a look at how this section of the manual will look next year (On “Revised” codes, strikethroughs denote what’s being deleted from 2022 definition; underlines denote what’s being added to 2023 definition):

Revised:

• 69717 Revision or rReplacement (including removal of existing device), osseointegrated implant, skull; with percutaneous attachment to external speech processor
• 69719 … with magnetic transcutaneous attachment to external speech processor, within the mastoid and/or involving a bony defect less than 100 sq mm surface area of bone deep to the outer cranial cortex
• 69726 Removal, entire osseointegrated implant, skull; with percutaneous attachment to external speech processor
• 69727 … with magnetic transcutaneous attachment to external speech processor, within the mastoid and/or involving a bony defect less than 100 sq mm surface area of bone deep to the outer cranial cortex

New:

• 69728 (Removal, entire osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, outside the mastoid and involving a bony defect greater than or equal to 100 sq mm surface area of bone deep to the outer cranial cortex)
• 69730 (Replacement (including removal of existing device), osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, outside the mastoid and involving a bony defect greater than or equal to 100 sq mm surface area of bone deep to the outer cranial cortex)

Impact: The revisions to 69717 mean you cannot code for a revision of an osseointegrated implant with this code — only a replacement. The 69719 and 69727 codes will each add “within the mastoid and/or involving a bony defect less than 100 sq mm surface area of bone deep to the outer cranial cortex” to their descriptors.

The new codes will each add a procedure to one of the revised codes for this section of the manual. The 69730 code will appear as an option under the parent code 69717; the 69728 code will appear as an option under the parent code 69726.

T Codes Get 1 Deletion, 2 Additions

The category III codes (T codes) in CPT^® 2023 will include some changes that neurosurgery coders will want to note.

First, CPT^® will delete +0163T (Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), each additional interspace, lumbar (List separately in addition to code for primary procedure)). Since CPT^® added +22860 for 2023 based on FDA approval, Category II code +0163T was no longer necessary. Note that the removal of this Category III code means that a three-level lumbar disc arthroplasty has neither a category I nor a category III code, which is expected given that a three-level lumbar disc replacement has not been rigorously evaluated nor FDA-approved.

Second, CPT^® will add the following category III codes to its 2023 roster:

• 0719T (Posterior vertebral joint replacement, including bilateral facetectomy, laminectomy, and radical discectomy, including imaging guidance, lumbar spine, single segment)
• 0720T (Percutaneous electrical nerve field stimulation, cranial nerves, without implantation)

T code reminder: Category III codes are temporary (T) codes used to gauge the effectiveness of emerging technologies, services, and procedures. Payers are likely to vary significantly on how they would like these codes used, so contact each individual payer before reporting 0719T or 0720T.