Neurosurgery Coding Alert

CPT^® will also revise these revision/removal codes.

The list of new, revised, and deleted codes for CPT^® 2024 are out — and neurosurgery coders need to take note.

Why? There are several procedures that your surgeon will perform that got their own codes this year. The new additions will update severalcode sets in CPT^®, making it clear what code to choose for these services.

But you’ve got to know the codes before you know how to use them. Read on to take that step.

Note These New Tethering Codes

These codes will debut in CPT^® 2024:

• 22836 (Anterior thoracic vertebral body tethering, including thoracoscopy, when performed; up to 7 vertebral segments)
• 22837 (Anterior thoracic vertebral body tethering, including thoracoscopy, when performed; 8 or more vertebral segments)
• 22838 (Revision (eg, augmentation, division of tether), replacement, or removal of thoracic vertebral body tethering, including thoracoscopy, when performed)
• 27278 (Arthrodesis, sacroiliac joint, percutaneous, with image guidance, including placement of intra-articular implant(s) (eg, bone allograft[s], synthetic device[s]), without placement of transfixation device)

Analysis: Codes 22836, 22837, and 22838 will be added to the spinal instrumentation codes +22840 (Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure)) through 22855 (Removal of anterior instrumentation).

“While most codes in this section are considered add-on codes, several — including anterior thoracic vertebral body tethering — are standalone codes,” explains Gregory Przybylski, MD, Chairman of Neuroscience at the New Jersey Neuroscience Institute, JFK University Medical Center in Edison, New Jersey. “The anterior thoracic vertebral tethering procedures are typically performed thoracoscopically and are the only service performed, hence their designation as standalone codes that are subject to the multiple procedure rule should additional standalone services be concurrently performed.”

The addition of 27278 to the 27279 (Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed, and placement of transfixing device) through 27286 (Arthrodesis, hip joint (including obtaining graft); with subtrochanteric osteotomy) code set gives coders another option when reporting these surgeries.

Comment: “Numerous sacroiliac fusion devices have been developed, with several different surgical approaches applied for their placement. CPT^® 27278 distinguishes devices in which the implanted device does not transfix — cross the joint with fixation in both the ilium and sacrum — the sacroiliac joint,” says Przybylski. “A direct posterior approach is typically applied for placement of a non-transfixing device during percutaneous sacroiliac joint fusion.”

Check Out These Device Insertion Codes

CPT^® 2024 will also premiere these new codes:

• 61889 (Insertion of skull-mounted cranial neurostimulator pulse generator or receiver, including craniectomy or craniotomy, when performed, with direct or inductive coupling, with connection to depth and/or cortical strip electrode array(s))
• 61891 (Revision or replacement of skull-mounted cranial neurostimulator pulse generator or receiver with connection to depth and/or cortical strip electrode array(s))
• 61892 (Removal of skull-mounted cranial neurostimulator pulse generator or receiver with cranioplasty, when performed)
• 64596 (Insertion or replacement of percutaneous electrode array, peripheral nerve, with integrated neurostimulator, including imaging guidance, when performed; initial electrode array)
• 64597 (Insertion or replacement of percutaneous electrode array, peripheral nerve, with integrated neurostimulator, including imaging guidance, when performed; each additional electrode array (List separately in addition to code for primary procedure))
• 64598 (Revision or removal of neurostimulator electrode array, peripheral nerve, with integrated neurostimulator)

Analysis: The addition of 61889 through 61892 will make the intracranial neurostimulator set — codes 61850 (Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical) through 61888 (Revision or removal of cranial neurostimulator pulse generator or receiver) — more robust. Likewise, adding 64596 through 64598 will broaden the code set for peripheral nerve neurostimulators, which is currently 64553 (Percutaneous implantation of neurostimulator electrode array; cranial nerve) through 64595 (Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver).

Note This Pair of Revisions

There will also be two CPT^® code revisions relevant to neurosurgery coders in 2024. Here’s a look at these codes:

(What’s being deleted is underlined and struck through; what’s being added is underlined and in bold.)

• Current descriptor: 63685 (Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling)
• Revised descriptor: 63685 (Insertion or replacement of spinal neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver)
• Current descriptor: 63685 (Revision or removal of implanted spinal neurostimulator pulse generator or receiver)
• Revised descriptor: 63688 (Revision or removal of implanted spinal neurostimulator pulse generator or receiver, with detachable connection to electrode array)