Neurosurgery Coding Alert

E/M section will be further altered in coming years.

The last couple of years have seen many changes in how you code your providers’ services. From evaluation and management (E/M) changes to telehealth expansion to the new CPT^® codes we get every year, things are moving quickly.

No need to worry though. We’re on top of what you should look for in the coming years in terms of coding changes.

Take a look at some changes you can expect to hit in 2022 and 2023.

The Future: Arthrodesis Add-ons

In January, you’ll have some new add-on codes to go with a few revised codes:

• +63052 (Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] [eg, spinal or lateral recess stenosis]), during posterior interbody arthrodesis, lumbar; single vertebral segment (List separately in addition to code for primary procedure))
• +63053 (Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] [eg, spinal or lateral recess stenosis]), during posterior interbody arthrodesis, lumbar; each additional segment (List separately in addition to code for primary procedure))

In its 2022 manual, CPT^® has offered some clarification on when to use these codes, and how. Per CPT^®, follow these rules with +63052 and +63053:

• Use +63053 in conjunction with +63052.
• Use +63052, +63053 in conjunction with:
  • 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar)
  • +22632 (… each additional interspace (List separately in addition to code for primary procedure))
  • 22633 (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)
  • +22634 (… each additional interspace and segment (List separately in addition to code for primary procedure)).

The Future: More Big E/M Changes

Evaluation and management (E/M) service code revisions will go big in 2023 — when an anticipated explosion of change occurs in the E/M section of the CPT^® manual. The AMA has said that this is in the proposed schedule, to take effect January 2023.

According to the AMA proposal, the expected changes include:

• Deletion of observation codes 99217 (Observation care discharge day management…) through 99226 (Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity.)
• Revisions of the guidelines for emergency department (ED), nursing facilities, and prolonged services.

Stay tuned: Nothing is set in stone for E/M changes in 2023 — but you can bet that big news is coming. Look for more information on potential 2023 E/M changes in future issues of Neurosurgery Coding Alert.