Neurosurgery Coding Alert

Continue to treat decompression as a separate procedure

You now have nine new codes to choose from when reporting placement, removal or revision of artificial disks. CPT category III (HCPCS) codes 0090T-0098T will become mandatory for all artificial disk procedures beginning July 1, 2005 - meaning that you should no longer turn to unlisted-procedure codes to report these services. Choose 0090T-0092T for Placement To report total disk arthroplasty (placement of artificial disk[s]), you should now call on one of two primary codes, depending on the area of the spine the surgeon treats, as well as a third code for any additional levels the surgeon treats beyond the first, says Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University department of surgery:

0090T - Total disk arthroplasty (artificial disk), anterior approach, including diskectomy to prepare interspace (other than for decompression); single interspace, cervical 

0091T - ... single interspace, lumbar 

+0092T - ... each additional interspace (list separately in addition to code for primary procedure). Example: The surgeon performs total disk arthroplasty with placement of artificial disks at L2/L3 and L3/L4. In this case, you should report 0091T (for the initial lumbar interspace) and 0092T (for the additional lumbar interspace).

What about thoracic? No code describes thoracic disk arthroplast. But, this shouldn't be a problem - at least now.

"No companies have pursued thoracic disk arthroplasty for three reasons," says Kee D. Kim, MD, associate professor at spinal neurosurgery and chief in the department of neurosurgery at the University of California at Davis in Sacramento. "Thoracic disk herniation is very rare, preserving motion in thoracic spine is not that important since there is little motion to begin with, and the approach to thoracic spine carries high risk." 0093T-0098T Describe Removals and Revisions Along with the placement codes, you'll also have three codes to describe removal of artificial disks and three codes to describe revisions, as follows:
0093T - Removal of total disk arthroplasty, anterior approach; single interspace, cervical 

0094T - ... single interspace, lumbar 

+0095T - ... each additional interspace (list separately in addition to code for primary procedure)

0096T - Revision of total disk arthroplasty, anterior approach; single interspace, cervical

0097T - ... single interspace, lumbar

+ 0098T - ... each additional interspace (list separately in addition to code for primary procedure). Don't report both removal and revision: When the surgeon removes and then replaces previously inserted artificial disks, you can report only the revision codes. Parenthetical references following the revision codes specifically state, "Do not report 0096T with 0093T," "Do not report 0097T with 0094T" and "Do not report 0098T with 0095T."

Translation: If the surgeon removes previously inserted artificial disks and then performs spinal fusion, for example, you should [...]