Neurosurgery Coding Alert

Question: Our neurosurgeon conducted a total disc arthroplasty on a patient. She also placed two artificial disks at L4/L5 and L3/L4. I reported the unlisted- procedure code for spinal procedures but received a denial. Why didn't the insurer accept the claim?


Mississippi Subscriber


Answer: You got a denial because you did not use the Category III (temporary) codes for this encounter. Check out this quick guide to properly coding total disc arthroplasties:

New way: Since June 2005, CPT requires you to report one primary code based on the location of the arthroplasty and a secondary code to represent any levels the physician treats beyond the initial level. In your case, you should:

- report 0091T (Total disc arthroplasty [artificial disc], anterior approach, including diskectomy to prepare interspace [other than for decompression]; single interspace, lumbar) for the first lumbar arthroplasty.

- report +0092T (... each additional interspace [list separately in addition to code for primary procedure]) for the second level. Don't forget that 0092T is an add-on code, meaning you can never report it without a primary CPT code.

Old way: In the past, you may have reported total disc arthroplasties with unlisted-procedure codes 22899 (Unlisted procedure, spine) or 64999 (Unlisted procedure, nervous system). But if a procedure has a Category III code, you have to use it. -If a Category III code is available, this code must be reported instead of a Category I unlisted code,- according to the American Medical Association.