Neurosurgery Coding Alert

3 new spinal codes and 1 skull procedure top the list of CPT 2005 changes

According to our sneak peek of the 2005 CPT manual, you can stop using unlisted-procedure code 22899 for open-door laminoplasty. Specifically, CPT 2005 will include two new codes to describe cervical laminoplasty:

63050 - Laminoplasty, cervical, with decompression of the spinal cord, two or more vertebral segments

63051 - ... with reconstruction of the posterior bony elements (including the application of bridging bone graft and non-segmental fixation devices (e.g., wire, suture, mini-plates), when performed.


Get ready for code changes now: Keep in mind that for 2005, neither Medicare payers nor practices billing Medicare payers are allowed the usual 90-day "grace period" to transition to the new codes. Beginning on Jan. 1, 2005, you must use CPT 2005 exclusively for Medicare payers, according to CMS transmittal 95.

Remember, however, that the new CPT codes aren't "official" until the AMA publishes them in the Federal Register later this month.

Don't Confuse Laminoplasty and Laminectomy

Laminoplasty differs from laminectomy, in which the surgeon removes the entire spinal lamina. In open-door laminoplasty, the surgeon decompresses the spinal cord while keeping the vertebral column's support system intact.

Expect some confusion: The descriptors for these codes, as released, seem problematic, says Eric Sandham, CHC, CPC, compliance manager for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno.

The descriptor for 63051 appears to be the definition of a classic open-door laminoplasty in which the surgeon typically creates a bridging bone graft after opening up the spine, so it's unclear what 63050 stands for, Sandham says. Also, both codes refer to "two or more vertebral segments," leaving the physician with no option if he just operated on one level.

"I foresee problems with these codes unless the 2005 CPT Changes guidebook and the editorial committee provide some additional guidance," Sandham says.

But ... a dedicated code is a definite advantage: "Working with multiple surgical specialties, we are continually having to use unlisted-procedure codes and then holding our breath for payment or requests for additional information," says Suzan Hvizdash, BSJ, CPC, physician education specialist for the department of surgery at UPMC Presbyterian-Shadyside in Pittsburgh. In contrast, with an established code, "We are able to set budgets and productive goals more accurately, and offer administration better financial reports. Coders are able to submit the claim electronically, and the turn-around time for reimbursement is better defined as well," she continues. For Dorsal Reconstruction, Look to 63295 If your surgeon conducts spinal reconstructions, you'll have a new code choice in 2005 with +63295 (Osteoplastic reconstruction of dorsal spinal elements, following primary intraspinal procedure [list separately in addition to [...]