Neurosurgery Coding Alert

Report interspinous spacer as distraction device, spinal bone grafts as prosthetic implants.

Understanding how to report Level II Healthcare Common Procedure Coding System (HCPCS) codes for spinal devices when these are not a part of your facility payment can make a difference to your claims for these services. "These do not apply to procedures performed at a facility not owned by you. While the codes reflect the facility reporting equipment and devices used, separate reimbursement may not be applicable if the devices are considered bundled into the facility payment," says Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison.

Check out this advice on reporting two frequently used spinal devices.

Question 1: Our surgeon performed an interspinous spacer procedure in a patient with lumbar spinal stenosis (LSS). How do we report the interspacer device and the procedure done?

Answer: For the implantation of the interspinous spacer, you report code C1821 (Interspinous process distraction device [implantable]). In addition, you report the CPT® codes for the procedure 0171T (Insertion of posterior spinous process distraction device [including necessary removal of bone or ligament for insertion and imaging guidance], lumbar; single level). This code includes any necessary removal of bone for placement and imaging guidance so you do not separately report any of these procedures. For each additional level in the spine where your surgeon uses the device, you report 0172T (Insertion of posterior spinous process distraction device [including necessary removal of bone or ligament for insertion and imaging guidance], lumbar; each additional level [List separately in addition to code for primary procedure]).

You report code 84.80 (Insertion or replacement of interspinous process device[s]) for this procedure. In addition, if your surgeon performs a synchronous surgical decompression you report code 03.09 (Other exploration and decompression of spinal canal) in addition to code 84.80.

Remember that if your surgeon places two devices in the same surgical session, you report the device once.

Question 2: Our surgeon used INFUSE® Bone Graft for a patient with degenerative disc disease. How do we report for the bone graft in this case?

Answer: In such a case, you will need to report a HCPCS code for the bone graft. You do not have any specific HCPCS code to specifically report the spinal bone graft. You report code L8699 (Prosthetic implant, not otherwise specified) for the spinal bone graft.