Neurosurgery Coding Alert

Question: I-ve recently come across an operative report for an -X-STOP- procedure. I-ve never heard of this. What is it, and how should I code for it?

Florida Subscriber

 

---

Answer: The X-STOP is a titanium implant designed to fit between the vertebrae's spinous processes in the lower back. The device allows for nerve decompression without significant soft or hard tissue excision.

Prior to this year, there was no code to describe this procedure, leaving you to report unlisted-procedure code 22899 (Unlisted procedure, spine) -- along with all of the hassles of an unlisted-procedure claim form.

For 2007, the AMA added a pair of Category III (temporary or -T-) neurosurgery codes (although these codes became effective Jan. 1, 2007, they did not make it into the CPT 2007 print version):

• 0171T-- Insertion of posterior spinous process distraction device (including��'necessary removal of bone or ligament for insertion and imaging guidance),��'lumbar; single level
• 0172T-- ... each additional level (list separately in addition to code for��'primary procedure).

Example: A patient with lumbar spinal stenosis reports to the neurosurgeon. The surgeon performs an X-STOP on three levels. On the claim, you should report the following:

• 0171T for the first level
• 0172T x 2 for the next two levels
• 724.02 (Spinal stenosis; lumbar region) linked to all the CPT codes to represent the patient's stenosis.

Many payers consider the X-STOP to be experimental and will not cover the procedure. The addition of the X-STOP codes is good news, however, because it means the X-STOP is gaining acceptance. The AMA assigning a Category III code is often the first step toward a procedure gaining permanent code status.