Neurosurgery Coding Alert
Know Code Family to Tackle Total Disc Arthroplasty
Here’s when you’ll need T codes to report these surgeries. When your surgeon performs a total disc arthroplasty, they’ll likely have already had visits with the patient to address and assess the condition that leads to the surgery. Coders need to be ready to report these services correctly or the practice could miss out on deserved reimbursement. When the surgery actually occurs, coders need to be ready to choose the correct codes to reflect that service as well. Want to be ready for total disc arthroplasty coding each time your surgeon performs it? Read on to get the lowdown on reporting these surgeries. Arthroplasty Could Sub for Fusion Often, a surgeon will perform a total disc arthroplasty in order to avoid doing a more involved surgery. “We do [arthroplasties] in place of a fusion procedure to maintain some mobility in the spine versus full fusion and fixating the spine together,” explains Kyle S. Nelson, M.D. of Metropolitan Neurosurgery, PA in Coon Rapids, Minnesota. “Theoretically, this would decrease the risk of adjacent segment disease.” Look to These CPT® Codes on Dx Services According to Nelson, arriving at a decision to perform total disc arthroplasty generally involves a combination of the following services: Note: This is not a complete list of the tests/services your surgeon might employ to identify total disc arthroplasty candidates. Always code to the notes and check your payer contract if you have questions regarding testing and services surrounding an arthroplasty. When the surgeon performs these services for an eventual total disc arthroplasty patient, they could be suffering from a number of different conditions. Nelson says these conditions are among the most common diagnoses that lead to total disc arthroplasty: The surgeon will also take other patient characteristics into account before performing the arthroplasty, such as “age, smoking status, bone quality [osteoporosis], and spinal alignment,” says Nelson. Include Previous Tx in Medical Record Remember, a total disc arthroplasty cannot be the first treatment that your surgeon performs for a patient. There has to be more conservative treatments attempted first, such as physical therapy (PT) or therapeutic injections, says Nelson. No matter the previous treatments, you must include documentation of the attempts in the medical record. Without this documentation, the payer might have a problem with your coding for total disc arthroplasty. Surgery Leads to These Codes When your surgeon does decide to pull the trigger on a total disc arthroplasty, you’ll report the service with one of the following codes, depending on encounter specifics: Note: Code +0163T (Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), each additional interspace, lumbar (List separately in addition to code for primary procedure)) was deleted for 2023, as it was redundant with 22860 and lumbar arthroplasty is not approved by the Food and Drug Administration (FDA) for application at more than two levels, explains Gregory Przybylski, MD, immediate past chairman of neuroscience and director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey. Note These Revision Codes You might also have a patient who needs revision of a disc arthroplasty. “Revision of a disc arthroplasty may be necessary to adjust its placement; or, alternatively, to remove the device and replace it with a new arthroplasty device. The latter would be performed if there is a failure of the initial device, but they can still replace the device with another one,” says Przybylski. Regardless of whether you replace the arthroplasty with the same or new device, Przybylski says you would report total disc arthroplasty revision with the following codes:
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