Orthopedic Coding Alert

Here’s when you’ll need T codes to report these surgeries.

Patients that report to your practice for total disc arthroplasty probably aren’t strangers to your providers. It’s likely they already visited the practice to address and assess the condition that leads to the surgery. Coders need to be ready to report these services correctly.

Then, when the surgery actually occurs, coders need to be ready to choose the correct codes for the procedure.

To be ready to code total disc arthroplasty each time your surgeon performs it, read on to get the lowdown on reporting these surgeries.

Arthroplasty Could Be Fusion Substitute

Often, a surgeon will perform a total disc arthroplasty in order to avoid doing a more involved surgery.

“We do [arthroplasties] in place of a fusion procedure to maintain some mobility in the spine versus full fusion and fixating the spine together,” explains Kyle S. Nelson, M.D. of Metropolitan Neurosurgery, PA in Coon Rapids, Minnesota. “Theoretically, this would decrease the risk of adjacent segment disease.”

Dx Services Often Lead to These CPT^® Codes

According to Nelson, arriving at a decision to perform total disc arthroplasty generally involves a combination of the following services:

• Evaluation and management (E/M) services, most likely office/outpatient E/Ms 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/ or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.) through 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.)
• Magnetic resonance imaging (MRI): 72141 (Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material)
• Computed tomography (CT): 72125 (Computed tomography, cervical spine; without contrast material)
• X-rays, such as 72040 (Radiologic examination, spine, cervical; 2 or 3 views), 72050 (… 4 or 5 views), or 72052 (… 6 or more views)

Note: This is not a complete list of the tests/services your surgeon might employ to identify total disc arthroplasty candidates. Always code to the notes and check your payer contract if you have questions regarding testing and services surrounding an arthroplasty.

When the surgeon performs these services for an eventual total disc arthroplasty patient, they could be suffering from a number of different conditions. Nelson says these conditions are among the most common diagnoses that lead to total disc arthroplasty:

• Degenerative disc disease
• Disc collapse
• Radiculopathy
• Foraminal stenosis

The surgeon will also take other patient characteristics into account before performing the arthroplasty, such as “age, smoking status, bone quality [osteoporosis], and spinal alignment,” says Nelson.

Previous Tx Must Be in Medical Record

Remember, a total disc arthroplasty cannot be the first treatment that your surgeon performs for a patient. There has to be more conservative treatments attempted first, such as physical therapy (PT) or therapeutic injections, says Nelson.

No matter the previous treatments, you must include documentation of the attempts in the medical record. Without this documentation, the payer might have a problem with your coding for total disc arthroplasty.

Surgery Leads to These Codes

When your surgeon does decide to pull the trigger on a total disc arthroplasty, you’ll report the service with one of the following codes, depending on encounter specifics:

• 22856 (Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); single interspace, cervical)
• +22858 (… second level, cervical (List separately in addition to code for primary procedure))
• 22857 (Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression); single interspace, lumbar)
• +22860 (… second interspace, lumbar (List separately in addition to code for primary procedure))

Note: Code +0163T (Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), each additional interspace, lumbar (List separately in addition to code for primary procedure)) was deleted for 2023, as it was redundant with 22860 and lumbar arthroplasty is not approved by the Food and Drug Administration (FDA) for application at more than two levels, explains Gregory Przybylski, MD, immediate past chairman of neuroscience and director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey.

Check Out These Revision Codes

You might also have a patient who needs revision of a disc arthroplasty. “Revision of a disc arthroplasty may be necessary to adjust its placement; or, alternatively, to remove the device and replace it with a new arthroplasty device. The latter would be performed if there is a failure of the initial device, but they can still replace the device with another one,” says Przybylski.

Regardless of whether you replace the arthroplasty with the same or new device, Przybylski says you would report total disc arthroplasty revision with the following codes:

• 22861 (Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical)
• +0098T (Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, cervical (List separately in addition to code for primary procedure))
• 22862 (Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar)
• +0165T (Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, lumbar (List separately in addition to code for primary procedure)).