Neurosurgery Coding Alert

Focus on procedure type, other factors, when determining code.

New procedural code changes aren't always easy to implement into your practice. Depending on the codes and their descriptors, the changes can often feel redundant and unnecessary. However, other times these changes come with a warm welcome to the individuals who utilize these codes on a regular basis.

Coders working in any given specialty are aware of the set of codes have been due for a revision for quite some time. When it comes to the 2017 CPT^® updates to spinal biomechanical device insertion codes, the general sentiment among coders is one of relief and excitement. But, despite the clarifications and modifications to these codes, there's still plenty to know when attempting to utilize them in the appropriate setting.

Check out these various helpful hints, tips, and tricks to making sure your biomechanical device coding is perfectly aligned with the most recent changes.

CPT^® Adds Clarity with New Codes

As you may be well aware, the 2017 procedural code changes included a brand-new set of codes for the insertion of biomechanical devices. Previously identified using one underlying code, 22851 (Application of intervertebral biomechanical devices[s] [eg, synthetic cage[s], methylmethacrylate] to vertebral defect or interspace [List separately in addition to code for primary procedure]), CPT® has done away with 22851 and replaced it with three more specified insertion device codes. The 2017 spinal biomechanical device codes are as follows:

• +22853, Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure)
• +22854, ...to vertebral corpectomy(ies) (vertebral body resection, partial or complete) defect, in conjunction with interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)
• +22859, Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)

When reviewing the new codes, the reason for the change from 22851 becomes clear. An article in the March 2017; Volume 27 Issue 3 of the CPT^® Assistant explains that, "After a review of utilization data by the stakeholder specialties, it was determined that code 22851 was reported for a variety of different cases that require different physician work and have different operative goals. A code change application was submitted to delete 22851 and create new codes that more accurately reflect the physician work involved in inserting spinal interbody and intervertebral biomechanical device(s)."

Differentiate Between 3 Biomechanical Device Codes

In order to know when, where, and how to implement these new biomechanical device codes, you've got to have a firm grasp on the similarities and, more importantly, the differences between the three codes. According to CPT^® Assistant, you will use +22853 "when an interbody biomechanical device is placed into a discectomy defect for purposes of a spinal fusion, such as a posterior lumbar interbody fusion (PLIF) procedure or an anterior cervical discectomy and fusion (ACDF) procedure."

On the other hand, you will code +22854 when the physician performs an insertion of a biomechanical device into a corpectomy defect. You will code +22854 when the surgeon performs the corpectomy for the purposes of a spinal fusion, rather than for a discectomy for a spinal fusion.

Finally, you should apply code +22859 when the surgeon does not perform a subsequent fusion at all. For instance, if the surgeon inserts a biomechanical device into a discectomy or corpectomy defect without a spinal fusion, you will apply code +22859.

"There was significant confusion initially, particularly regarding CPT^® +22853, says Gregory Przybylski, MD, interim chairman of neurosurgery and neurology at the New Jersey Neuroscience Institute, JFK Medical Center in Edison. "Many interpreted the CPT^® descriptor as limiting use of the device for anterior placement only."

"However, the intent of the language was to clarify the circumstances under which CPT^® +22845 is reported for anterior spinal fixation in addition to placement of an interbody prosthetic device when the procedure is performed anteriorly. The descriptor confirmed that integral fixation, in which screw fixation is performed through the device itself, precludes separate reporting of CPT^® +22845," Przybylski explains.

Remember: These biomechanical insertion device codes include many components included in the anchoring process. CPT® Assistant states: "As with codes +22853 and +22854, code +22859 also includes the integral anterior instrumentation for device anchoring (eg, screws, flanges) that are part of some devices." Some of these devices may include a screw or flange that the surgeon uses to anchor the cage into the disc space.