Orthopedic Coding Alert

Question: If the surgeon performs a lumbar spine oste-otomy (22214) and places an X-STOP device (0171T), may I report both codes to Medicare?

Massachusetts Subscriber

Answer: For services on or after July 1, you should report only 22214 (Osteotomy of spine, posterior or posterolateral approach, one vertebral segment; lumbar).

Reason: Correct Coding Initiative (CCI) version 14.2, effective July 1, deletes a previous column 1/column 2 edit bundling 22214 into 0171T (Insertion of posterior spinous process distraction device [including necessary removal of bone or ligament for insertion and imaging guidance], lumbar; single level). But, CCI version 14.2 also creates a new edit bundling 0171T into 22214.

Result: You should report only 22214 for Medicare and other payers who apply CCI edits. If you report the two codes together, Medicare will pay only 22214

Tip: CCI 14.2 makes the same column switch for another edit pair, now bundling 0171T into 22102 (Partial excision of posterior vertebral component [e.g., spinous process, lamina or facet] for intrinsic bony lesion, single vertebral segment; lumbar).

Watch out: CCI 14.2 creates a number of new mutually exclusive edits bundling 0171T into lumbar codes such as 22214 (Osteotomy of spine, posterior or posterolateral approach, one vertebral segment; lumbar) and 63017 (Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy [e.g., spinal stenosis], more than 2 vertebral segments; lumbar). Because these edits are mutually exclusive, if you report both codes in the edit pair together, Medicare will pay only the column 2 code.