Neurosurgery Coding Alert

New Category III codes for revision, removal or replacement of an artificial disc also take a hit

The long-awaited kyphoplasty CPT codes have been hit hard with bundling edits in NCCI version 12.0. You-ll be able to use a modifier to override some of these edits, but not all of them. This newest round of National Correct Coding Initiative (NCCI) edits took effect Jan. 1. New Codes Mean New Bundles If you want to start reporting kyphoplasty procedures using new CPT codes 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) and 22524 (- lumbar), be prepared to maneuver new bundling guidelines as well.

The newest NCCI edits bundle 22327 (Open treatment and/or reduction of vertebral fracture[s] and/or dislocation[s], posterior approach, one fractured vertebra or dislocated segment; thoracic) with 22523.

NCCI now bundles thoracic kyphoplasty with thoracic vertebroplasty (22520, Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic) and replacement of an intervertebral cage (22851, Application of intervertebral biomechanical device[s] [e.g., synthetic cage(s), threaded bone dowel(s), methylmethacrylate] to vertebral defect or interspace).

The edits also bundle lumbar kyphoplasty procedures with lumbar vertebroplasty (22521, ... lumbar) and the replacement of an intervertebral cage (22851).

NCCI 12.0 bundles the new kyphoplasty codes with several spine computed  tomography (CT) and fluoroscopy codes as well. See the box -Don't Report Spine CT, Fluoroscopy With Kyphoplasty- on page 10 for the exact bundles.

Neurosurgeons often perform spine computed tomography and fluoroscopy with kyphoplasty and vertebroplasty procedures, says Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University department of surgery in New York. These bundles also have a -1- modifier indicator so you can report them separately when appropriate.

Note: The new kyphoplasty procedure bundles are -mutually exclusive,- which means that a neurosurgeon would not ever reasonably perform the two procedures or services on the same patient at the same anatomical location during one session. The bundles do, however, have a modifier indicator of -1.- This means you may use modifiers to break the bundles and report the two procedures separately if circumstances allow, says Rena Hall, CPC, coder for the Kansas City Neurosurgery Group in Missouri. Therefore, if the neurosurgeon performs a kyphoplasty along with one of the bundled procedures but they are done on different levels, you can report both. NCCI Targets Artificial Disc Procedures You-re also faced with several bundling edits to the new Category III CPT codes for the revision, removal or replacement of an artificial disc (0090T-0097T). NCCI bundles cage placement (22851) and several minor procedures, such as anesthetic injections (64415-64417), with the total disc arthroplasty codes. See the Web site  www.cms.hhs.gov/NationalCorrectCodInitEd/ [...]