Neurosurgery Coding Alert

In a rare move, CMS increased the CF after the final rule this year.

The new year has arrived, and with it comes some clarifications on certain issues that coders will need to know in order to code correctly in 2022.

Nuts and bolts: The Medicare Physician Fee Schedule (MPFS) conversion factor (CF) was upped slightly — after the Centers for Medicare & Medicaid Services (CMS) published its final rule. Also, the first ^® errata of the year included several changes to codes you’ll need to know for your patients that receive spinal services from your provider.

Read on for all the CF and errata info you’ll need to code correctly.

Final CF Revised … Again

Initially, CMS proposed a Medicare Physician Fee Schedule (MPFS) 2022 conversion factor (CF) of $33.5848; but after public comments, they finalized a CF of $33.5983. But the story of the 2022 MPFS CF still wasn’t completely written.

Public response: The significant CF reduction as the COVID-19 public health emergency (PHE) continued didn’t go unnoticed by healthcare organizations. The American Medical Association (AMA) urged Congress to act to prevent further financial casualties.

It seems the public, professional pressure worked, if only slightly.

Revised 2022 rate: Late last year, CMS announced an updated 2022 CF of $34.6062. While this represents a 0.82% cut from the CY 2021 CF of $34.8931, it reflects an increase from the initial CY 2022 physician CF of $33.5983 announced in the CY 2022 MPFS final rule.

Check Out This Errata Breakdown

According to a general errata overview, CPT^® performed the following revisions to the CPT^® 2022 code set:

• “Revise codes and parenthetical notes throughout the Posterior, Posterolateral or Lateral Transverse Process Technique subsection.
• “Add ‘vertebral’ to the code descriptor for code 63053 and revise guidelines and multiple parenthetical notes throughout the Posterior Extradural Laminotomy or Laminectomy for Exploration/Decompression of Neural Elements or Excision of Herniated Intervertebral Discs and Transpedicular or Costovertebral Approach for Posterolateral Extradural Exploration/Decompression subsections.”

Takeaway: CPT^® made some changes that might seem minor, but coders must note each change in order to be in line with coding convention. Also, you’ll notice that not all of the following changes are contained in the code descriptors; you have to dig into the Notes section before you get to some of the revisions for the codes.

Arthrodesis Codes Get Tweaks

According to the errata, CPT^® made the following changes:

“Revise the Posterior, Posterolateral or Lateral Transverse Process Technique subsection by:

• “1) replacing semicolon with a comma following ‘interspace’ and adding a semicolon following ‘lumbar’ to the code descriptor for code 22630;
• “2) replacing semicolon with a comma following ‘interspace’ and adding semicolon following ‘lumbar’ to the code descriptor for code 22633;
• “3) removing ‘and segment’ from the code descriptor for code 22634; and
• “4) revising two parenthetical notes following code 22634 by adding ‘and vertebral segment[s]’.”

Here’s how the above-described changes will look in the CPT^® code descriptors (added content in bold underline; deleted content in bold strikethrough):

• 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/ or discectomy to prepare interspace (other than for decompression), single interspace; , lumbar;)
• 22633 (Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace;, lumbar;)
• +22634 (Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace, lumbar; each additional interspace and segment (List separately in addition to code for primary procedure))

Notes:

(Use 22634 in conjunction with 22633)

(Do not report 22633, 22634 in conjunction with 63030, 63040, 63042, 63047, 63052, 63053, 63056, for laminectomy performed to prepare the interspace on the same spinal interspace[s]) and vertebral segment[s])

(For decompression performed on the same interspace[s] and vertebral segment[s] as posterior interbody fusion that includes laminectomy, removal of facets, and/or opening/widening of the foramen for decompression of nerves or spinal components, such as spinal cord, cauda equina, or nerve roots, see 63052, 63053)

Errata Also Examines These Laminotomy Codes

According to the errata, CPT^® also made the following changes:

“Add ‘vertebral’ to the code descriptor for code 63053 and revise guidelines and multiple parenthetical notes throughout the Posterior Extradural Laminotomy or Laminectomy for Exploration/Decompression of Neural Elements or Excision of Herniated Intervertebral Discs and Transpedicular or Costovertebral Approach for Posterolateral Extradural Exploration/Decompression subsections.”

Here’s how the above-described changes will look in the CPT^® code descriptors (added content in bold underline; deleted content in bold strikethrough):

• +63035 (Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; each additional interspace, cervical or lumbar (List separately in addition to code for primary procedure))

Notes:

(Use 63035 in conjunction with 63020-63030) (Do not report 63030, 63035 in conjunction with 22630, 22632, 22633, 22634, for laminotomy performed to prepare the interspace for fusion on the same spinal interspace[s]) and vertebral segment[s]) (For decompression performed on the same interspace and vertebral segment[s] as posterior interbody fusion that includes laminectomy, removal of facets, and/or opening/widening of the foramen for decompression of nerves or spinal components, such as spinal cord, cauda equina, or nerve roots, see 63052, 63053) (For bilateral procedure, report 63035 twice. Do not report modifier 50 in conjunction with 63035) (For percutaneous endoscopic approach, see 0274T, 0275T)

• +63044 (Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; each additional lumbar interspace (List separately in addition to code for primary procedure))

Notes:

(Use 63044 in conjunction with 63042) (Do not report 63040, 63042, 63043, 63044 in conjunction with 22630, 22632, 22633, 22634, for laminotomy to prepare the interspace[s] for fusion on the same interspaces and vertebral segment[s]) (For decompression performed on the same vertebral segment[s] and/or interspace[s] and vertebral segment[s] as posterior interbody fusion that includes laminectomy, removal of facets, and/or opening/widening of the foramen for decompression of nerves or spinal components, such as spinal cord, cauda equina, or nerve roots, see 63052, 63053)

(For bilateral procedure, report 63044 twice. Do not report modifier 50 in conjunction with 63044) Decompression performed on the same interspace(s) and vertebral segment(s) and/or interspaces as posterior interbody fusion that includes laminectomy, facetectomy, or foraminotomy may be separately reported using 63052.

Codes 63052, 63053 may only be reported for decompression at the same anatomic site(s) when posterior interbody fusion (eg, 22630) requires decompression beyond preparation of the interspace(s) for fusion.

• +63048 (Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; each additional vertebral segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure))

Notes:

(Use 63048 in conjunction with 63045-63047) (Do not report 63047, 63048 in conjunction with 22630, 22632, 22633, 22634, for laminectomy performed to prepare the interspace for fusion on the same interspace[s] and vertebral segment[s] and/or interspace[s])

(For decompression performed on the same interspace[s] and vertebral segment[s] and/or interspace[s] as posterior interbody fusion that includes laminectomy, removal of facets, and/or opening/widening of the foramen for decompression of nerves or spinal components, such as spinal cord, cauda equina, or nerve roots, see 63052, 63053)

• +63053 (Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] [eg, spinal or lateral recess stenosis]), during posterior interbody arthrodesis, lumbar; each additional vertebral segment (List separately in addition to code for primary procedure))
• +63057 (Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment; each additional segment, thoracic or lumbar (List separately in addition to code for primary procedure)).

Notes:

(Use 63057 in conjunction with 63055, 63056)

(Do not report 63056, 63057 for a herniated disc in conjunction with 22630, 22632, 22633, 22634 for decompression to prepare the interspace on the same interspace[s] and vertebral segment[s])

(For decompression performed on the same interspace[s] and vertebral segment[s] as posterior interbody fusion that includes laminectomy, removal of facets, and/or opening/ widening of the foramen for decompression of nerves or spinal components, such as spinal cord, cauda equina, or nerve roots, see 63052, 63053)

View the errata for yourself at https://www.ama-assn.org/practice-management/cpt/cpt-errata-technical-corrections.