Orthopedic Coding Alert

You should be separately billing for moderate sedation with percutaneous vertebral procedures.

2017 brought some revisions to coding for percutaneous spinal procedures, and you might already be noticing some differences to your bottom line. These changes may not sound significant, but they can impact your reimbursement. Make sure you are applying correctly or risk a negative financial impact.

Note the Drift in Moderate Sedation Services

You should have already implemented these revisions for percutaneous vertebroplasty codes: 22510 (Percutaneous vertebroplasty [bone biopsy included when performed], 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic), 22511 (Percutaneous vertebroplasty [bone biopsy included when performed], 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; lumbosacral), and +22512 (Percutaneous vertebroplasty [bone biopsy included when performed], 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; each additional cervicothoracic or lumbosacral vertebral body [List separately in addition to code for primary procedure]).

What was the change? In 2017, these codes for percutaneous vertebroplasty lost the component for moderate sedation or conscious sedation.

“There has been an AMA workgroup that has been tasked for quite some time to address issues related to moderate sedation,” says Gregory Przybylski, MD, interim director of neurosurgery and neurology at the New Jersey Neuroscience Institute, JFK Medical Center in Edison. “Factors that have been evaluated include determining which procedures have moderate sedation performed by the physician doing the procedure as an inherent part of the procedure and, if not, how to value these services based on who is providing them.”

What does this mean for coders? You can separately bill for sedation when your physician documents the use of sedation for the procedure. Depending upon the time of sedation and the age of the patient, you select a code from the range of 99151 (Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient younger than 5 years of age) through 99157 (Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; each additional 15 minutes intraservice time [List separately in addition to code for primary service]) for moderate sedation.

Kyphoplasty and Annuloplasty Follow Same Change

Similar revisions apply to the codes for percutaneous kyphoplasty, 22513 (Percutaneous vertebral augmentation, including cavity creation [fracture reduction and bone biopsy included when performed] using mechanical device [e.g., kyphoplasty], 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic) - 22515 (……each additional thoracic or lumbar vertebral body [List separately in addition to code for primary procedure]).

Note: The codes for percutaneous vertebroplasty (22510 – 22512) and percutaneous kyphoplasty (22513 – 22515) are inclusive of imaging guidance that your surgeon may use for these procedures.

Percutaneous augmentation and annuloplasty codes, 22526 (Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level) and 22527 (... 1 or more additional levels (List separately in addition to code for primary procedure]) also follow the same change.

Accept the Fall in Reimbursements

These revisions in 22510, 22511, and 22512 have brought about a negative financial impact. For example, the revised RVUs for code 22510 (facility) are 12.63 making a total payment of $453.27, which is a fall from $468.68 in 2016.

Though the codes for percutaneous kyphoplasty follow the fall in reimbursement as in percutaneous vertebroplasty, the codes for percutaneous augmentation and annuloplasty do not seem to be affected. The codes 22526 and +22527 are not covered by Medicare in 2017 nor were these codes covered earlier by Medicare.

Make note: No RVUs have yet been assigned to code the new code 62380 (Endoscopic decompression of spinal cord, nerve root[s], including laminotomy, partial facetectomy, foraminotomy, discectomy and/or excision of herniated intervertebral disc, 1 interspace, lumbar) for endoscopic decompression of spinal nerves. We are still waiting for the RVUs to be determined.

“The endoscopic discectomy procedure was valued by the AMA Relative-value Update Committee in 2016. This was placed on a new technology list,” Przybylski says. “However, CMS did not publish RVUs for this procedure.”