Neurosurgery Coding Alert

Question: I need to prepare a surgical estimate for a 2-level anterior cervical discectomy and fusion which will take place in Jan. 2011. What are the new arthrodesis codes and the associated RVUs and Medicare fee schedule amount? Thanks in advance for your help.

New York Subscriber

Answer: Starting Jan. 1, you will be required to report arthrodesis procedures that include discectomy, osteophytectomy and spinal cord decompression with two new bundled codes:

• 22551 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2
• 22552 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2, each additional interspace (List separately in addition to code for separate procedure) Code 22552 is an add-on code, so you would report it with 22551 to reflect any additional interspace the neurosurgeon treats below C2. Previously, this bundled procedure would have been reported as 63075 (Discectomy, anterior, with decompression of spinal cord and/or nerve root[s], including osteophytectomy; cervical, single interspace) for the discectomy, osteophytectomy and spinal cord/nerve decompression and 22554-51 (Arthrodesis, anterior interbody technique, including minimal discectiomy to prepare interspace [other than for decompression]; cervical below C2) (Reduced services) for the arthrodesis.

The work RVUs for 22551 are 25.0 and for 22552 are 6.5, while the total facility RVUs for 22551 are 51.20 and for 22552 are 11.93 (subject to geographical variation). The fee schedule conversion factor proposed in the 2011 Medicare Physician Fee Schedule Final Rule is $25.5217.