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 [...]