Orthopedic Coding Alert

Also, there’s a significant pair of revisions to note.

The list of new, revised, and deleted codes for CPT^® 2024 are out, and it is a big year for chiropractic practices that perform a lot of spinal procedures.

Why? There are several procedures that your surgeon likely already performs that got their own codes this year. The new additions will update several code sets in CPT®, making it clear what code to choose for each type of surgery in the set.

Read on to learn the new codes before they take effect on January 1, 2024.

Get to Know New Tethering Codes

These codes will debut in CPT® 2024:

• 22836 (Anterior thoracic vertebral body tethering, including thoracoscopy, when performed; up to 7 vertebral segments)
• 22837 (Anterior thoracic vertebral body tethering, including thoracoscopy, when performed; 8 or more vertebral segments)
• 22838 (Revision (eg, augmentation, division of tether), replacement, or removal of thoracic vertebral body tethering, including thoracoscopy, when performed)
• 27278 (Arthrodesis, sacroiliac joint, percutaneous, with image guidance, including placement of intra-articular implant(s) (eg, bone allograft[s], synthetic device[s]), without placement of transfixation device)

Analysis: Codes 22836, 22837, and 22838 will be added to the spinal instrumentation codes +22840 (Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure)) through 22855 (Removal of anterior instrumentation).

“While most codes in this section are considered add-on codes, several — including anterior thoracic vertebral body tethering — are standalone codes,” explains Gregory Przybylski, MD, Chairman of Neuroscience at the New Jersey Neuroscience Institute, JFK University Medical Center in Edison, New Jersey. “The anterior thoracic vertebral tethering procedures are typically performed thoracoscopically and are the only service performed, hence their designation as standalone codes that are subject to the multiple procedure rule should additional standalone services be concurrently performed.”

The addition of 27278 to the 27279 (Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed, and placement of transfixing device) through 27286 (Arthrodesis, hip joint (including obtaining graft); with subtrochanteric osteotomy) code set gives coders another option when reporting these surgeries.

Comment: “Numerous sacroiliac fusion devices have been developed, with several different surgical approaches applied for their placement. CPT® 27278 distinguishes devices in which the implanted device does not transfix — cross the joint with fixation in both the ilium and sacrum — the sacroiliac joint,” says Przybylski. “A direct posterior approach is typically applied for placement of a non-transfixing device during percutaneous sacroiliac joint fusion.”

Note This Pair of Revisions

There will also be two CPT^® code revisions relevant to orthopedic coders in 2024. Here’s a look at these codes:

(What’s being deleted is underlined and struck through; what’s being added is underlined and in bold.)

• Current descriptor: 63685 (Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling)
• Revised descriptor: 63685 (Insertion or replacement of spinal neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver)
• Current descriptor: 63688 (Revision or removal of implanted spinal neurostimulator pulse generator or receiver)
• Revised descriptor: 63688 (Revision or removal of implanted spinal neurostimulator pulse generator or receiver, with detachable connection to electrode array)