Important 2012 CPT Coding Changes to ASC Spine & Pain Management Procedures

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The following article is written by Stephanie Ellis, RN, CPC, president of Ellis Medical Consulting.

CPT changes to spine procedure coding

Codes 22520, 22521 and 22522: These CPT codes were changed from a percutaneous vertebroplasty, 1 vertebral body, unilateral or bilateral injection; thoracic or lumbar and add-on code for an additional level, to now include a bone biopsy, if one is performed as part of the percutaneous vertebroplasty procedure.

The AMA made a major change to the anterior cervical discectomy and fusion procedure coding in the CPT book in 2011. When anterior cervical fusions are performed, usually a discectomy is also performed. For dates of service in 2010 and before, two codes (63075 for the discectomy and 22554 for the fusion) were required. For 2011, CPT combined these two procedures into one code. Use code 22551 for the first level of cervical fusion and discectomy performed and add-on code 22552 for subsequent levels. Codes 63075 and 22554 are still valid for use in cases where only those individual procedures are performed.

Now for 2012, the AMA is making similar changes to the lumbar and thoracic codes for posterior fusion procedures for 2012 by combining commonly performed procedures into one code.

The 22610 code for an arthrodesis (fusion) using the posterior or posterolateral technique, single level; thoracic now states this code is done with the lateral transverse technique (the code previously stated with or without).

Code 22612 for an arthrodesis, posterior or posterolateral technique, single level; lumbar now states this code is done with the lateral transverse technique (the code previously stated with or without). This code has an instructional note to not report the 22612 code with code 22630 for an arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar. The codes can only be billed together when the procedures are performed at different spinal levels.

The new CPT code for use instead for the PLIF (posterior lumbar interbody fusion) procedure for 2012 would now be 22633 for an arthrodesis, combined posterior or posterolateral technique with posterior interbody technique, including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar. Use new add-on code 22634 for additional lumbar levels performed.

The 62287 code for a lumbar percutaneous discectomy procedure has also been revised by the AMA for 2012. Code 62287 for the decompression procedure, percutaneous, of intervertebral disc, was revised to state that it is performed by "any method which utilizes a needle-based technique to remove disc material under fluoroscopic guidance or other form of indirect visualization, with the use of an endoscope, with discography and/or epidural injection(s) at the treated level(s), when performed," single or multiple levels, lumbar. Use of an endoscopic approach was not previously stated; use of discograms and imaging and an epidural injection are all new verbiage to this code. Therefore, now code 62287 cannot be billed with codes 62267, 62290, 62311 or imaging codes 77003, 77012 or 72295, when performed at the same level. CPT directs that if a percutaneous discectomy is performed as a non-needle-based technique to use new Category III CPT codes 0276T or 0277T, as appropriate.

Very commonly performed CPT codes for spinal discectomy procedures have also been revised, and are now for use for open procedures only, as follows:

• Code 63020 for a cervical discectomy [laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, 1 interspace, cervical] has now been revised for 2012 to exclude the endoscopically assisted approach.

• Code 63030 for a lumbar discectomy [laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, 1 interspace, lumbar] has now been revised for 2012 to exclude the endoscopically assisted approach.

CPT instructional notes now state to use the following Category III codes for use of the endoscopic approach:

• Use code 0274T for a percutaneous laminotomy/laminectomy (intralaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy) any method under indirect image guidance (e.g., fluoroscopic, CT), with or without the use of an endoscope, single or multiple levels, unilateral or bilateral; cervical or thoracic.

• Use code 0275T for a percutaneous laminotomy/laminectomy (intralaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy) any method under indirect image guidance (e.g., fluoroscopic, CT), with or without the use of an endoscope, single or multiple levels, unilateral or bilateral; lumbar.

CPT changes to pain management procedure codes

In 2011, the AMA revised thetransforaminal dpidural steroid injection codes to include the use of imaging (fluoroscopy or CT) and imaging used in the procedure, making the imaging no longer separately billable with code 77003-TC, as it was previously in 2010.

For 2012, the AMA is now doing the same thing with the epidural steroid injection (ESI) CPT codes 62310 (cervical or thoracic ESI), 62311 (lumbar or sacral ESI), 62318 (cervical or thoracic by continuous infusion) and 62319 (lumbar or sacral) by continuous infusion). These four codes now include the contrast for localization, when it is used in the ESI procedures, making the use of contrast no longer separately billable with radiology code 77003.

On spinal cord neurostimulator codes, some minor revisions have been made to the CPT codes, as follows:

• Code 64561 for the percutaneous implantation of neurostimulator electrode array of the sacral nerve (transforaminal placement) for an InterStim used for an overactive bladder (which is usually used for stage I trial procedures) has been revised to add the word "array (electrode array) instead of just electrode. CPT instructs to use new Category III codes 0282T-0284T when implanting trial or permanent electrode arrays or pulse generators to be used for peripheral subcutaneous field stimulation procedures.

• The same change was made to code 64581 for incision for implantation of neurostimulator electrode array of the sacral nerve (transforaminal placement) for the stage II permanent InterStim procedure, where the word "array" was added to the code descriptor.

• Code 64585 for the revision or removal of a peripheral neurostimulator electrode array also added the word "array" to the code descriptor. There was no change to the code for the implantation of the generator used in the permanent procedure.

Codes for Radiofrequency procedures on Facet Joints have changed for 2012 in the CPT book. The following codes have been deleted for 2012:

• Code 64622 for destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level has been deleted.

• Add-on code 64623 for destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, each additional level (list separately in addition to code for primary procedure) has been deleted.

• Code 64626 for destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, single level has been deleted.

• Add-on code 64627 for destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, each additional level (list separately in addition to code for primary procedure) has been deleted.

These four codes have been replaced by the following new CPT codes for 2012:

• Use code 64633 for the destruction of paravertebral facet joint nerve(s) by neurolytic agent with fluoroscopy or CT image guidance; cervical or thoracic, single facet joint for the first level performed. The add-on code for additional levels is code 64634.

• Use code 64635 for the destruction of paravertebral facet joint nerve(s) by neurolytic agent with fluoroscopy or CT image guidance; lumbar or sacral, single facet joint for the first level performed. The add-on code for additional levels is code 64636.

• CPT code 77003 for fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) was revised for 2012. The words "(…or sacroiliac joint), including neurolytic agent destruction" were eliminated from the coding descriptor for this code.

Note: For information on 2012 CPT arthroscopy revisions, read "2012 CPT Arthroscopy Revisions Pose Financial Hit to Both ASCs and Surgeons" by Cristina Bentin, CCS-P, CPC-H, CMA, president of Coding Compliance Management, by clicking here.

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