Neurosurgery Coding Alert

2006 changes save you from using another unlisted-procedure code

After years of waiting, you-ll finally have three codes (22523-22525) for reporting kyphoplasty starting in January 2006. Experts caution, however, that the new codes don't necessarily mean you-ll start receiving payment on kyphoplasty procedures and you may not be able to separately bill follow-up care anymore.

Get to Know the 3 New Codes

The kyphoplasty codes will cover thoracic, lumbar and each additional thoracic or lumbar vertebral body as indicated in the code descriptors:

- 22523--Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, one vertebral body, unilateral or bilateral cannulation (e.g., kyphoplasty); thoracic

- 22524---lumbar

- +22525---each additional thoracic or lumbar vertebral body (list separately in addition to code for primary procedure).

These new codes mirror the existing codes for percutaneous vertebroplasty, which surgeons actually perform less often, says Heidi Stout, coding and reimbursement specialist with University Orthopedic Associates in New Brunswick, N.J. The technique is different for thoracic and lumbar kyphoplasty, because you-re dealing with different levels of the spine, she says.

You No Longer Need S2362, S2363

Until now, you-ve had to use either HCPCS codes S2362 (Kyphoplasty, one vertebral body, unilateral or bilateral injection) or S2363 (Kyphoplasty, one vertebral body, unilateral or bilateral injection; each additional vertebral body [list separately in addition to code for primary procedure]) or an unlisted-procedure code for this type of procedure. A kyphoplasty procedure involves the surgeon creating a cavity in a collapsed vertebra and injecting cement to reconstruct and reinforce the remaining bone, says Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University department of surgery in New York City.

-These are fairly common procedures nowadays, but there was never a good code to use,- Sandhusen says. -Very few payers have taken the trouble to develop payments and profiles for those S codes.- Often, neurosurgeons didn't get paid for kyphoplasty procedures because some payers didn't recognize S2362 or S2363, he adds.

Your alternative to reporting the S codes was to assign 22899 (Unlisted procedure, spine). Many payers- policies directed you to report kyphoplasty procedures using 22899, listing in box 19 that the neurosurgeon performed a kyphoplasty procedure and the level. For example, you would write in -T4 kyphoplasty,- Sandhusen says.
 
Medicare May Assign New Global Surgical Periods

Many carrier policies paid separately for post-operative care when billing 22899 for kyphoplasty procedures. In other words, 22899 has a zero-day global surgical period and you could separately bill any follow-up care. With the three new kyphoplasty codes from the American Medical Association, Medicare will very likely assign a payment profile and global surgical period, Sandhusen says. -It's not just changing the codes you use, it's changing your billing process as well,- he adds.

New Codes Don't Necessarily Mean Reimbursement

The addition of new CPT codes doesn't mean you-ll get paid for kyphoplasty, says Jeff Fulkerson, CPC, a coder for the department of radiology at The Emory Clinic in Atlanta. The majority of carriers still view kyphoplasty as an experimental, noncovered procedure. But now that there are codes, it's easier to force the issue.