Orthopedic Coding Alert

CPT introduces 5 new spine codes

After years of waiting, orthopedic coders can finally start using designated CPT codes for kyphoplasty, starting on Jan. 1. CPT 2006 debuts three new codes to report this service (22523-22525), which replace the temporary or unlisted-procedure codes that you previously reported.

In 2006, coders should select one of the following new codes when the surgeon performs kyphoplasty:

- 22523--Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, one vertebral body, unilateral or bilateral cannulation (e.g., kyphoplasty); thoracic

- 22524---lumbar

- +22525---each additional thoracic or lumbar vertebral body (list separately in addition to code for primary procedure).

Old way: In the past, coders used HCPCS temporary codes S2362 (Kyphoplasty, one vertebral body, unilateral or bilateral injection) and S2363 (...each additional vertebral body [list separately in addition to code for primary procedure]) when billing most private payers.

However, surgeons primarily perform kyphoplasty procedures on Medicare patients, says Leslie Follebout, CPC, coding department supervisor at Peninsula Orthopaedic Associates in Salisbury, Md. In the past, Medicare payers required coders to assign the unlisted-procedure code 22899 (Unlisted procedure, spine) to kyphoplasty claims.

Although some carriers paid swiftly for kyphoplasty claims in the past, most payers were hit-or-miss. Some insurers required very specific verbiage in various boxes on their kyphoplasty claims, while others required letters from the surgeon explaining the procedure.

New Codes May Not Mean Better Reimbursement Odds

The addition of new CPT codes doesn't mean you-ll necessarily get paid easily for kyphoplasty, says Jeff Fulkerson, BA, CPC, CMC, senior certified coder at The Emory Clinic in Atlanta. Some insurers, such as Aetna and Cigna, still view kyphoplasty as an experimental, non-covered procedure, and those that do reimburse for kyphoplasty may continue to publish very limited diagnoses that warrant billing the new codes.

For example: Now, Noridian Administrative Services (a Part B payer in 11 states) covers kyphoplasty (using the unlisted-procedure code) only when billed with diagnosis code 733.13 (Pathologic fracture of vertebrae). Other payers list a wider range of diagnoses for the procedure. In 2006, carriers may continue to provide limited kyphoplasty coverage despite the new codes, coding experts say.

Diagnosis coding tip: Such fractures almost always occur secondary to osteoporosis and can therefore be considered -pathologic.- You-ll find that 733.13 applies to most of your patients who require kyphoplasty treatment.
 
CMS recently released the 2006 relative value units for the new kyphoplasty codes, paying about $589 for thoracic kyphoplasty (22523), $565 for lumbar (22524), and about $270 for each additional level (22525).

Note: These payment amounts are not yet adjusted for geographic differences.

Fluoro update: CPT 2006 also revises the radiological supervision and interpretation codes 76012 (Radiological supervision and interpretation, percutaneous vertebroplasty or vertebral augmentation including cavity creation, per vertebral body; under fluoroscopic guidance) and 76013 (- under CT guidance) to reflect that you can now report these codes with 22523-22525.

Look for Better Spinal I&D Payment 
 
The new edition of CPT also introduces two codes that describe incision and drainage (I&D) of deep abscesses on the posterior spine:

- 22010--Incision and drainage, open, of deep abscess (subfascial), posterior spine; cervical, thoracic, or cervicothoracic

- 22015---lumbar, sacral, or lumbosacral.

Coders are hoping that the new I&D codes will help reflect the higher level of complexity and risk associated with treating a postoperative wound infection after spinal surgery.

Old way: In the past, coders had no choice other than to report 10180 (Incision and drainage, complex, postoperative wound infection) for such postoperative infections, even when the surgeon had to open the spine to perform the I&D. Despite the difficulty of the procedure, Medicare assigned only 4.50 relative value units (RVUs) to 10180, leaving orthopedic surgeons short on reimbursement for these procedures.

Big money increase: However, the 2006 Medicare Physician Fee Schedule assigns a whopping 21.69 RVUs to 22010, and 21.50 RVUs to 22015, giving spine surgeons nearly a 500 percent pay increase for these services.