Orthopedic Coding Alert

Check out 4 new neurostimulator codes coming your way for Jan. 1.

Additional neurostimulator and arthrodesis codes are just two of the plusses in the new and revised codes your orthopedic practice will have on hand in 2011.

In fact, CPT will introduce over 200 new codes in 2011 and revise over 90 codes to help keep your coding more specific than ever, spanning a number of specialties, from dermatology to orthopedics to cardiology, and beyond.

Make Room for Extra Arthrodesis Specificity

Starting Jan. 1, you will be required to report arthrodesis procedures that include discectomy, osteophytectomy and spinal cord decompression with two new bundled codes:

• 22551 -- Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2
• 22552 -- Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2, each additional interspace (List separately in addition to code for separate procedure)

Code 22552 is an add-on code, so you would report it with 22551 to reflect any additional interspace the neurosurgeon treats below C2. "Previously, this bundled procedure would have been reported as 63075 (Discectomy, anterior, with decompression of spinal cord and/or nerve root[s], including osteophytectomy; cervical, single interspace) for the discectomy,osteophytectomy and spinal cord/nerve decompression and 22554-51 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression]; cervical below C2) (Reduced services) for the arthrodesis," advises Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison. "This is one of several code pairs which were used together more than 90 percent of the time, prompting CMS to request a bundled code from CPT."

Add More Neurostimulator Codes

Starting Jan. 1, you will be able to more fully describe tibial and cranial neurostimulator services with four new codes:

• 64566 -- Posterior tibial neurostimulation, percutaneous needle electrode, single treatment, includes programming
• 64568 -- Incision for implantation of cranial nerve (e.g., vagus nerve) neurostimulator electrode array and pulse generator
• 64569 -- Revision or replacement of cranial nerve (e.g., vagus nerve) neurostimulator electrode array, including connection to existing pulse generator
• 64570 -- Removal of cranial nerve (e.g., vagus nerve) neurostimulator electrode array and pulse generator

And if your neurosurgeon performs chemodenervation, you will have a new code to report for work on the salivary glands:

• 64611 -- Chemodenervation of parotid and submandibular salivary glands,bilateral

Watch Halo, Allograft, and Vertebral Fracture Revisions

Don't let code descriptor changes trip you up when you turn to 20664 for halo application, as the 2011 revision removes the phrase "requiring general anesthesia:"

20664 (Revised) -- Application of halo, including removal, cranial, 6 or more pins placed, for thin skull osteology (e.g., pediatric patients, hydrocephalus, osteogenesis imperfecta)

Add-on allograft codes 20930 and 20931 received changes, which will be for 2011:

20930 (Revised) -- Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure)

20931 (Revised) -- Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure)

"The development of many bone graft extenders including demineralized bone matrix and bone morphogenic protein led to frequent questions regarding the appropriate coding for these materials," Przybylski explains. "The revision of 20930 places these materials in the same category as other non-structural bone extenders that are not obtained directly from the patient being treated."

Closed vertebral facture code 22315 now omits the phrase "with or without anesthesia":

22315 (Revised) -- Closed treatment of vertebral fracture(s) and/or dislocation(s) requiring casting or bracing, with and including casting and/or bracing by manipulation or traction

And code 22851 for application of intervertebral biomechanical devices deletes "threaded bone dowels" from the definition:

22851 (Revised) -- Application of intervertebral biomechanical device(s) (e.g., synthetic cage(s), methylmethacrylate) to vertebral defect or interspace (List separately in addition to code for primary procedure)

The rationale: "The production of machined allografts led to frequent questions regarding the appropriate coding for placing these materials," says Przybylski. "As the machined allografts are bone allograft materials, the correct code to describe their use was 20931. However, the example of threaded bone dowel in code 22851 led to confusion that prompted removal of this example from 22851, which was intended to describe placement of structural devices composed of non-bony prosthetic material (e.g., Titanium, carbon fiber, PEEK)."