Neurosurgery Coding Alert

The American Medical Associations (AMA) CPT changes for 2001 indicate a more straightforward approach for coding many neurosurgical procedures such as vertebroplasty, laminotomies, intracranial aneurysms and computed tomography (CT) and magnetic resonance (MR) scans.

The AMA has changed the wording for clarification and added some important codes, explains Cindy Parman, CPC, CPC-H, co-owner of Coding Strategies Inc., an Atlanta-based billing and reimbursement firm. The modifications outlined in CPT 2001 will take effect Jan. 1, 2001, for Medicare, although it may take longer for other carriers to adopt them. It is never too early for coders to brush up on new changes, and the following will serve to explain some of the revisions. Parman advises coders to work closely with carriers to determine when to begin implementing the new codes.

Vertebroplasty Codes Finally Available

Codes describing percutaneous vertebroplasty have been added to CPT 2001. The absence of codes for this procedure has been a source of concern for neurosurgery coders. Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno, states that most people code this procedure with 64999 (unlisted procedure, nervous system) or 62287 (aspiration or decompression procedure, percutaneous, of nucleus pulposus of intervertebral disk, any method, single or multiple levels, lumbar [e.g., manual or automated percutaneous diskectomy, percutaneous laser diskectomy]). The misuse of 62287 is one of the main reasons the new codes were created.

The new vertebroplasty procedural codes include:

22520 (percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic)

22521 (... lumbar)

+22522 (... each additional thoracic or lumbar vertebral body [list separately in addition to code for primary procedure]).

These new additions will be supported by radiology codes 76012 (radiological supervision and interpretation, percutaneous vertebroplasty, per vertebral body; under fluoroscopic guidance) and 76013 (... under CT guidance).

New Chemodenervation Code For Extremities

Neurosurgery providers who use botulinum toxin (botox) injections to treat spastic muscle disorders should be pleased with the introduction of a code for injections to the extremities and/or trunk muscles. Previously, there were no specific codes designated for chemodenervation to the extremities. Sandham states that the creation of 64614 (chemodenervation of muscle[s]; extremity[s] and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]) necessitated the accompanying change in 64612. The words chemodenervation of muscle end plate have been replaced with chemodenervation of muscle, which is a more accurate statement of the procedure.

As before, the botox itself should be coded separately using J0585.

Laminotomy Interspace

CPT 2001 has revised 63040 (laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial fecetectomy, foraminotomy and/or excision of herniated interveterbral disk, reexploration, single interspace; cervical) [...]