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/ for the specific code bundles.

NCCI also now bundles many of the same codes into the new incision and drainage codes (22010-22015) and kyphoplasty codes (22523-22524). -These are fairly standard bundles that are created when new codes are added to avoid separate billing for the anesthesia that's included in the surgery,- Sandhusen says.

-I am concerned about the addition of a bundling edit for fluoroscopy with 22523 (kyphoplasty),- Hall says. -This means that the additional work provided by the surgeon is not going to be paid. It will be interesting to see if there is going to be an allowed increase in the RVU totals for these codes to compensate for the bundling.- Unfortunately, it's unlikely you-ll see additional compensation.

Tip: Don't report +69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]), 76000 or 76001 with 0090T-0097T. Neurosurgeons often use microdissection or fluoroscopy during artificial disc procedures, Sandhusen says. NCCI now bundles them so you can't separately report the microdissection or fluoroscopy and the artificial disc procedure.

Take Note of NCCI Deletions

You-ll also want to pay attention to a few of the deletions NCCI implemented on Jan. 1. Codes 64470 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level) and 64475 (-lumbar or sacral, single level) are no longer bundled with 95867 (Needle electromyography; cranial nerve supplied muscle[s], unilateral) or 95868  (- cranial nerve supplied muscles, bilateral).

NCCI has also deleted several bundles between 64550 (Application of surface [transcutaneous] neurostimulator) and other codes for services such as electroencephalogram (95822), electromyography (95860-95861, 95870) and nerve conduction studies (95900, 95904).