Neurosurgery Coding Alert

Example: The surgeon performs total disk arthroplasty with placement of artificial disks at L2/L3 and L3/L4. In this case, you should report 0091T (for the initial lumbar interspace) and 0092T (for the additional lumbar interspace).

What about thoracic? No code describes thoracic disk arthroplast. But, this shouldn't be a problem - at least now.

"No companies have pursued thoracic disk arthroplasty for three reasons," says Kee D. Kim, MD, associate professor at spinal neurosurgery and chief in the department of neurosurgery at the University of California at Davis in Sacramento. "Thoracic disk herniation is very rare, preserving motion in thoracic spine is not that important since there is little motion to begin with, and the approach to thoracic spine carries high risk."

0093T-0098T Describe Removals and Revisions

Along with the placement codes, you'll also have three codes to describe removal of artificial disks and three codes to describe revisions, as follows:

Don't report both removal and revision: When the surgeon removes and then replaces previously inserted artificial disks, you can report only the revision codes. Parenthetical references following the revision codes specifically state, "Do not report 0096T with 0093T," "Do not report 0097T with 0094T" and "Do not report 0098T with 0095T."

Translation: If the surgeon removes previously inserted artificial disks and then performs spinal fusion, for example, you should report the appropriate removal code(s) (for instance, 0093T), along with the appropriate fusion code (such as, 22554, Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace [other than for decompression]; cervical below C2) and any related procedures, Kim says.

If, however, the surgeon removes the artificial disk and replaces it with a new artificial disk, you should report only the revision procedure (in this case, 0096T). The revision includes removal of the "old" artificial disk.

Avoid 22851, Unlisted Codes for Artificial Disks

When placing (0090T-0092T) or replacing (0096T-0098T) artificial disks, you should rely on the T codes only to describe the service. You should not, for instance, report 22851 (Application of intervertebral biomechanical device[s] [e.g., synthetic cage(s), threaded bone dowel(s), methylmethacrylate] to vertebral defect or interspace) in addition to 0090T-0092T or 0096T-0098T to describe artificial disk procedures.

Exception: You may report 22851 during the same session as 0090T-0092T/0096T-0098T, but only if the surgeon places an intervertebral biomechanical device at a different level. In other words, you can use 22851 to describe instrumentation placed elsewhere on the spine during artificial disk procedures, Sandhusen says.

Don't avoid T codes: Likewise, you should no longer report an unlisted-procedure code, such as 22899 (Unlisted procedure, spine) or 64999 (Unlisted procedure, nervous system), to describe artificial disk procedures. The use of 0090T-0098T becomes mandatory to describe these procedures as of July 1, 2005. "If a Category III code is available, this code must be reported instead of a Category I unlisted code" [emphasis in the original], according to AMA guidelines.

Decompression Is Separate, Fluoroscopy's Not

When appropriate, you can bill separately for spinal decompression (63001-63048) in addition to artificial disk procedures, Kim says.

Example: To alleviate pressure on the spinal cord and thereby reduce patient pain, the surgeon performs foraminotomy for decompression at interspace C3/C4. At this time, the surgeon also removes a herniated disk at C3/C4 and replaces it with an artificial disk.

In this case, report 63045 (Laminectomy, facetectomy and foraminotomy [unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s), (e.g., spinal or lateral recess stenosis)], single vertebral segment; cervical) for the decompression and 0090T for placement of the artificial disk at one cervical interspace.

Stay away from fluoroscopy codes: Unlike decompression, however, you should not separately report fluoroscopic guidance during artificial disk procedures. Parenthetical instructions that accompany the new codes specifically state that 0090T-0098T "include fluoroscopy when performed."