Code Spinal Decompression with Confidence
Use of two Category III codes depends on newly-revised CPT® code 62287
By G.J. Verhovshek, MA, CPC
As of July 1, 2011 you have two added Category III codes from which to choose to describe decompression of the spine. The additions required the revision of an existing decompression code in CPT® 2012, also. Here are the facts to apply the new and revised codes correctly.
Select Decompression Codes by Location, Approach, Method
Spinal decompression procedures are performed to remove pressure from spinal nerves and to relieve pain caused by problems such as a herniated disc or sciatica. Surgical decompression methods may be either percutaneous (though the skin) or incisional (a traditional “open” approach).
Codes and coding guidelines to report incisional spinal decompression (e.g., 63001-63103, or 22551-22552 with arthrodesis) have not changed for 2012. Proper code selection depends on the location of the surgery (e.g., cervical, thoracic, etc.); approach (e.g., posterior extradural, transpedicular, anteriolateral, etc.); extent of the procedure (e.g., does it include facetectomy, foraminotomy, discectomy, etc.); and reason for the procedure (e.g., for decompression only, to remove abnormal facets, tumor removal, etc.). No special coding is necessary when an open procedure is performed with endoscopic assist.
Just as there are a variety of incisional decompression surgeries, so too are there several kinds of percutaneous procedures. Two codes—implemented July 1, 2011 and first included in CPT® 2012—describe the most novel of these procedures:
0274T Percutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy), any method, under indirect image guidance (eg, fluoroscopic, CT), with or without the use of an endoscope, single or multiple levels, unilateral or bilateral; cervical or thoracic
Codes 0274T and 0275T describe image-guided minimally invasive lumbar decompression (IG-MLD), also referred to as the mild® procedure. The epidural space is filled with contrast medium under fluoroscopic guidance. The surgeon gains access to the affected area via a 6-gauge cannula (a hollow portal), and employs single-use tools to sculpt bone and tissue to relieve nerve pressure. Additional contrast media may be added throughout the procedure to aid visualization of the decompression. The process is repeated on the opposite side for bilateral decompression of the central canal. This method does not require fixation/stabilization devices or spacers, and can be conducted under a combination of local anesthetic and monitored anesthesia care (MAC), rather than general anesthesia.
Code 0274T describes such a technique in either the cervical or thoracic regions of the spine, and 0275T applies to the lumbar spine.
Both 0274T and 0275T include all portions of the service, whether unilateral or bilateral and regardless of the number of levels addressed. Do not separately report image guidance, use of an endoscope, ligamentous resection, discectomy, facetectomy, or foraminotomy.
For example, if the surgeon performs a mild® procedure bilaterally at (lumbar) levels L1, L2, and L3, you would report a single unit of 0275T. The procedure includes indirect image guidance, as well as the bone and ligament results necessary to decompress the spinal nerve(s).
Needle-based Technique Differs
The addition of 0274T and 0275T required the revision of existing Category I CPT® code 62287 Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method, single or multiple levels, lumbar (eg, manual or automated percutaneous discectomy, percutaneous laser discectomy), which now specifically describes percutaneous decompression of the nucleus pulposus of intervertebral disc using a needle-based technique. Also called percutaneous discectomy, the procedure removes part of the nucleus pulposus (the gel center) from a ruptured disk to decrease pressure on a spinal nerve root and relieve pain.
Code 62287 applies to single or multiple levels, and includes fluoroscopic imaging or other indirect visualization; do not report such imaging (e.g., 77003, 77012, 72295) when performed at the same level. Do not report percutaneous aspiration with the nucleus pulposus (62267), discography injection (62290), or diagnostic/therapeutic lumbar injection (62311) in addition to 62287. The procedure also includes endoscopic approach (do not report endoscopic assist separately).
For example, the surgeon places a needle into the affected disc (L2/L3 interspace) under fluoroscopic imaging. Endoscopic instruments are introduced to the center of the disc, and a series of channels are created to remove tissue from the nucleus. Proper reporting is one unit of 62287.
Note that 62287 applies to the lumbar region only. If performed in another region of the spine (cervical, thoracic), percutaneous discectomy would be reported using an unlisted procedure code (e.g., 64999 Unlisted procedure, nervous system).
G.J. Verhovshek, MA, CPC, is managing editor at AAPC.