Orthopedic Coding Alert

Insurers expect you to use the new codes by Jan. 1

If you-re still reporting 0091T for your surgeon's lumbar total disc arthroplasties, you-ll soon be facing denials for using -deleted codes.-

In our November Orthopedic Coding Alert, we gave you a sneak peek of the new codes that insurers will be asking you to use this year for your surgeon's services. The following tips can help you learn the nuances of a few of these new codes.

Use 22857 for Lumbar Arthroplasties

CPT 2007 significantly alters how you should report lumbar total disc arthroplasties. The AMA deleted three disc arthroplasty codes from the Category III section and gave them permanent codes, says Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University department of surgery. Further, CPT revised the definitions of the remaining Category III disc arthroplasty codes.

When your surgeon performs this procedure this year, you should report 22857 (Total disc arthroplasty [artificial disc], anterior approach, including discectomy to prepare interspace [other than for decompression], lumbar, single interspace), Sandhusen says.

Old way: Formerly, you had to code these arthroplasties with 0091T (Total disc arthroplasty [artificial disc], anterior approach, including discectomy to prepare interspace [other than for decompression]; single interspace, lumbar), which CPT deleted for 2007.

Moving lumbar total disc arthroplasties from Category III to Category I (permanent) code status is a sign that the procedure has gained more industry acceptance, says Beth Janeway, CPC, CCS-P, CCP, president of Carolina Healthcare Consultants in Winston-Salem, N.C.

-CPT only assigns Category I codes when a procedure is safe and effective, and approved by physicians and the medical community,- she says. Moving lumbar arthroplasties to Category I -shows that the treatment has good outcomes, and that the procedure is going to stick around,- Janeway says.

Experts: Coding Gets Easier With Category I Code

Coders will have an easier time garnering payment for lumbar total disc arthroplasties with 22857 than they had with the T code, Janeway says. When a code moves from temporary to permanent status, Medicare assigns the code relative value units (RVUs). Once a procedure has RVUs assigned to it, Medicare and private payers generally accept the treatment more widely, Janeway says.

There's also a new code to use when the surgeon performs a total disc arthroplasty on more than one lumbar interspace. When this occurs, report new code +0163T (Total disc arthroplasty [artificial disc], anterior approach, including discectomy to prepare interspace [other than for decompression], lumbar, each additional interspace) for each additional interspace.

-Performing lumbar disc arthroplasties at multiple levels is still considered to be relatively experimental, which is why you have to use a T code [instead of a regular CPT code],- Sandhusen says.

For example, your surgeon performs a lumbar arthroplasty at three separate interspaces. On the claim, you should:

- report 22857 for the first interspace.

- report 0163T x 2 for the other two interspaces.

New Code Governs Lumbar Arthroplasty Revision

The AMA also made some changes to coding for lumbar disc arthroplasty revisions and removals -- both of these procedures now have permanent codes, Sandhusen says.

When your surgeon performs a revision of the total disc lumbar arthroplasty, you should report 22862 (Revision including replacement of total disc arthroplasty [artificial disc] anterior approach, lumbar, single interspace).

If the surgeon revises more than one interspace during the procedure, use +0165T (Revision of total disc arthroplasty, anterior approach, lumbar, each additional interspace) with 22862.

For example, your physician revises a total lumbar disc arthroplasty at three interspaces. On the claim, you should:

- report 22862 for the first revision.

- report 0165T x 2 for the next two revisions.

Old way: Spine practices formerly used 0097T (Revision of total disc arthroplasty, anterior approach; single interspace, lumbar) to code this type of revision, but that code was scratched from this year's manual.

Prosthesis Removal Gets a Permanent Code

When your surgeon removes the lumbar disc prosthesis, you now have a permanent CPT code to reflect this procedure. When you code removals in 2007, you should report 22865 (Removal of total disc arthroplasty [artificial disc], anterior approach, lumbar, single interspace).
 
If the surgeon removes the artificial disc at more than one interspace during the procedure, use +0164T (Removal of total disc arthroplasty, anterior approach, lumbar, each additional interspace) with 22865.

For example, if the surgeon removes a total lumbar disc arthroplasty at three interspaces, you should:

- report 22865 for the first removal.

- report 0164T x 2 for the other two removals.

Old way: Coders previously used 0094T (Removal of total disc arthroplasty, anterior approach; single interspace, lumbar) to report lumbar prosthetic disc removals, but the AMA deleted that code.

Find Cervical Arthroplasty Codes in Category III

Not all total disc arthroplasties got permanent CPT codes this year. While you-ll report lumbar arthroplasties with 22857 from now on, you-ll still use the T codes to report services and procedures associated with cervical arthroplasties, Sandhusen says.

Cervical arthroplasties are still in Category III, while CPT moved lumbar arthroplasties to the permanent codes section. The AMA made this change because of each procedure's utilization rates, Janeway says.

Surgical practices conduct lumbar arthroplasties quite often, -while they do not perform cervical arthroplasties as often. This is probably why they are still in Category III,- Janeway says.

So if your surgeon conducts a cervical total disc arthroplasty, you should report these codes:

- 0090T (Total disc arthroplasty [artificial disc], anterior approach, including discectomy to prepare interspace [other than for decompression] cervical; single interspace) for the procedure.

- 0093T (Removal of total disc arthroplasty, anterior approach cervical; single interspace) for removal.

- 0096T (Revision of total disc arthroplasty, anterior  approach cervical; single interspace) for a revision