AAOS Now November 2016 aaosnow.org

26 Managing Your Practice

Spine surgeons face a multi-tude of Current Procedural Terminology® (CPT) code

changes, effective Jan. 1, 2017. This article provides a summary of these changes so practices can get a head start on understanding their implications. A complete listing of changes can be found in the 2017 CPT manual.

Approach and visualization de� nitions The Spine and Spinal Cord section of the Nervous System codes in CPT 2017 provides new defi nitions of key terms and surgical approach-es to further clarify these CPT code descriptors, as shown in Table 1.

Surgical CPT codes are presumed to be open unless the code descrip-tor states otherwise.

Intervertebral deviceOne of the key coding changes for spine surgeons is the deletion of CPT code +22851, previously defi ned as “application of interver-tebral biomechanical device(s) (eg, synthetic cage(s), methyl methac-rylate) to vertebral defect or inter-space (List separately in addition to code for primary procedure).”

Data from the Centers for Medi-care & Medicaid Services (CMS) identifi ed +22851 as a “fastest growing procedure” in 2008 and then as a “high expenditure pro-cedure” in 2011, refl ecting the in-creased use of these devices. More importantly, survey data showed that +22851 was not always ac-curately used, which likely contrib-uted to the utilization increase.

Three new CPT codes have been created for 2017 to replace the de-leted code. Table 2 shows each of the three new codes with its corre-sponding descriptor and comments about how each code is to be used.

Like +22851, the new codes are add-on codes and are never ap-pended with modifi er 51 (multiple procedures). Several instructional and add-on code parenthetical notes have been added to the CPT manual to clarify the deletion of +22851 and the addition of thesenew codes.

Closed treatment of vertebral process fractureCPT 22305 (Closed treatment of vertebral process fracture[s]) will be deleted due to low utilization. Providers are instructed to use an evaluation and management (E/M) code instead.

Posterior spinous process deviceTable 3 shows the four new codes established to describe the insertion of an interlaminar/interspinous pro-cess stabilization/distraction device. The codes are differentiated based on whether or not decompression was also performed. These codes will replace the Category III codes 0171T (Insertion of posterior spi-nous process distraction device [in-cluding necessary removal of bone or ligament for insertion and imag-ing guidance], lumbar; single level) and +0172T, the associated add-on code for each additional level.

All four new codes include any imaging guidance (such as fl uoros-copy) required to insert the device. Additionally, none of these codes may be reported with other spine procedures codes, including specifi c arthrodesis, instrumentation, and decompression codes.

Interlaminar epidural or subarachnoid injectionsCodes 62310 and 62311 will be deleted and each will be replaced with two new codes to describe the procedures being performed (Table 4). The new codes are assigned based on whether imaging guid-

ance is used. CMS identifi ed the deleted codes as “potential misval-ued,” citing data showing that the services were typically performed with imaging guidance.

A similar change applies to codes 62318 (cervical or thoracic) and 62319 (lumbar or sacral), which described the injection as includ-ing indwelling catheter place-ment with continuous infusion or intermittent bolus codes. Both 62318 and 62319 will be deleted. New codes for cervical or thoracic injections—62324 (without imag-ing guidance) and 62325 (with imaging guidance—as well as for lumbar or sacral injections—62326 (without imaging guidance) and 62327 (with imaging guidance)—are being introduced.

Other changesA new lumbar endoscopic decom-pression code—62380 (Endoscopic decompression of spinal cord, nerve root[s], including laminoto-my, partial facetectomy, foraminot-omy, diskectomy and/or excision of herniated intervertebral disk, 1 interspace, lumbar)—is being added. This code may be reported with modifi er 50 when a bilateral procedure is performed.

As a result of this new code addi-tion, code 62287, the percutaneous intervertebral disk decompression code, is being revised to remove the words “with the use of an endoscope.”

2017 Spine CPT Code Changes� KIM POLLOCK, RN, MBA, CPC, CMDP

TABLE 1: NEW DEFINITIONS APPLYING TO SPINE PROCEDURES FOR 2017

Approach Type of Visualization

Percutaneous Image-guided procedures (such as CT or � uoroscopy) performed with indirect visualization of the spine without the use of any device that allows visualization through a surgical incision

Endoscopic Continuous direct visualization through an endoscope

Open Continuous direct visualization through a surgical opening

Indirect Image-guided (such as CT or � uoroscopy); not light-based visualization

Direct Light-based visualization; can be performed by eye or with surgical loupes, microscope, or endoscope

TABLE 2: REPLACEMENT CODES FOR +22851

Code 2017 Descriptor Comments

+22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, � anges), when performed, to intervertebral disk space in con-junction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure)

Code per each treated intervertebral disk space

Example: PEEK device, low-pro� le or integrated de-vice placed in an interspace for arthrodesis

+22854 Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) with integral anterior instrumentation for device anchoring (eg, screws, � anges), when performed, to vertebral corpectomy(ies) (vertebral body resection, partial or complete) defect, in conjunction with interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)

Code per each contiguous corpectomy defect when there is also an arthrodesis

Example: PEEK device, expandable cage, low-pro� le or integrated device placed into a corpectomy defect for arthrodesis

Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to intervertebral disk space or vertebral body defect without interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)

Code for each contiguous disk space or corpectomy defect when there is no arthrodesis

Example: Spinal reconstruction with prosthetic re-placement of resected vertebral body without place-ment of bone graft

TABLE 3: NEW CODES FOR INSERTION OF AN INTERLAMINAR/INTERSPINOUS PROCESS STABILIZATION/DISTRACTION DEVICE

Code 2017 Descriptor

Insertion of the device with open decompression22867 Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when per-

formed, with open decompression, lumbar; single level

+22868 Second level (List separately in addition to code for primary procedure)

Insertion of the device without open decompression22869 Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image

guidance when performed, lumbar; single level

+22870 Second level (List separately in addition to code for primary procedure)

> SEE CODING ON PAGE 29

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