The first set of spine codes for neurosurgery billing and orthopedic billing that have been revised for 2017 are CPT codes 22510-22512 for the percutaneous vertebroplasty.  There actually is very little revision to these in some of the subsequent codes.  The only thing that the AMA has done with these is they’ve taken off the indicator for moderate sedation and now they’ve said that any sedation applies.  AMA has also added a new moderate sedation code CPT 99151.  They’ve taken off the CCI edits for this code.  If you are a surgeon and you are providing the moderate sedation services for any of these three codes we would suggest that you attempt to bill CPT code 99151, which is based on time and/or 99152 or 99153 which also is based on time and age of the patient.  So for these codes the only revision is that they’ve taken off the indicator for “must be provided under moderate sedation”.

 

The following Percutaneous Vertebroplasty codes have been revised:

  • 22510* – cervicothoracic
  • 22511* – lumbosacral
  • +22512* – each additional vertebral body

*These codes are inclusive of all imaging guidance.

*These codes can now be performed under any type of sedation.

 

Additional orthopaedic billing spine codes that have been similarly revised taking off the indicator for moderate sedation and now including any sedation.  If you are providing the moderate sedation and you’re the surgeon we would recommend using CPT code 99151 to 99153 based on time and age of patient in addition to the surgical procedure codes.  It’s noteworthy that all of these codes for the percutaneous vertebroplasty and kyphoplasty all are inclusive of imaging guidance.

 

The following Percutaneous Vertebroplasty codes have also been revised:

  • 22513* -thoracic
  • 22514* -lumbar
  • +22515* -each additional vertebral body

*These codes are inclusive of all imaging guidance.

*These codes can now be performed under any type of sedation.

 

Reimbursement

Very few orthopedic billing codes have not gone down in reimbursement this year, although a few have gone up.  We have also seen that in many cases the procedure definition has been revised to be a more complex procedure, although there has not been a corresponding increase in the RVUs.  The Medicare allowed rate for these codes have all gone down for 2017:

 

CPT 2016 2017 Change
22510  $  506.18  $  485.12 -4.2%
22511  $  475.59  $  455.37 -4.3%
22512  $  232.72  $  230.12 -1.1%

*Shown is the Orange County, California medical billing Medicare allowable, which varies by Locality

*Facility Rates

 

The Medicare allowed rate for these codes have also all gone down for 2017:

 

CPT 2016 2017 Change
22513  $  602.98  $  577.37 -4.2%
22514  $  562.65  $  537.95 -4.4%
22515  $  251.73  $  246.90 -1.9%

*For example shown is the Orange County, California Medicare allowable, which varies by Locality.

*Facility Rates

 

 

Percutaneous Augmentation and Annuloplasty

The AMA has revised these codes to remove the indicator for moderate sedation and any sedation now applies.

  • 22526 – single level
  • +22527- one or more additional levels

*These codes are inclusive of all imaging guidance.

*These codes can now be performed under any type of sedation.

 

Reimbursement

$0 – Medicare has not covered these orthopedic billing codes in quite some time and has not changed this policy for 2017.

 

CPT 22851 was a fairly generic application of a biomechanical device or in most cases some sort of cage. It is still somewhat confusing on what they’ve done with this and there is not a lot of guidance available.  They have deleted CPT code 22851, but they’ve added three new CPT codes to replace this.  The differences appear to be the manner in which these biomechanical devices or the cages are applied.

 

Spine Surgery Application of Biomechanical Device or Cage

Deleted:

22851 – Application of biomechanical device or cage to defect or interspace

Replaced With:

  • 22853 – Insertion of interbody biomechanical cage w/integral anterior instrumentation for device anchoring; to intervertebral disc space in conjunction w/interbody fusion, each interspace
  • 22854 – to vertebrectomy defect with interbody fusion, each contiguous defect
  • 22859 – to intervertebral disc space or vertebrectomy defect without interbody fusion, each contiguous defect

 

22853 specifies that it’s in conjunction with interbody fusion and it’s a code that’s applied to each interspace just like the old code 22851.  CPT 22854 is for a vertebrectomy, which is somewhat new that they would specify what this CPT code is to be applied to.  CPT 22851 was fairly generic and they’ve added at the end instead of each interspace each contiguous defect.  22859 is different than 22853 and specifies that it’s without interbody fusion and at the end they specified each contiguous defect.  This means is that we are going to ask you the spine surgeon to give us a little bit greater specificity in your operative reports in order to know which of these three codes need to be assigned.  22851 was fairly easy in the application because it was fairly generic.

 

Reimbursement

Reimbursement dropped significantly for these codes.  None of the three reimburse even close to what the old code paid.

CPT 2016 2017 Change
22851  $  454.58
22853  $  285.08 -37.3%
22854  $  369.06 -18.8%
22859  $  369.06 -18.8%

 

 

Two new orthopedic billing codes for spine are 22867 and 22869 for stabilization or distraction device.  These codes specify with and without open decompression. Each has a corollary add on code for a second level 22868 and 22870 respectively.

 

Insertion of interlaminar / interspinous process stabilization/distraction device, without fusion including image guidance, with open decompression, lumbar;

  • 22867 – single level
  • +22868 – second level

 

Insertion of interlaminar/interspinousprocess stabilization/distraction device, without fusion including image guidance, without open decompression, lumbar;

  • 22869 – single level
  • +22870 – second level

 

These are new orthopedic codes, so there is no financial change implication in 2017 from 2016 since they didn’t exist prior to then.

 

Endoscopic decompression of spinal cord, nerve root, including laminotomy, partial facetectomy, foraminotomy, discectomy and/or excision of herniated intervertebral disc

  • 62380* – 1 interspace

*Can be billed as bilateral.

*Previously coded as 63030.

 

CPT code 63030 was the code that we previously build for a micro discectomy even though it didn’t specify with or without a microscope.  It was the only code that could be applied.  AMA have now given us a code for the endoscopic decompression of spinal cord microdiscectomy.  It can be billed bilaterally; depending on payer we would add right, left or 50 modifier.

 

As of December 2016 Medicare had not yet assigned a reimbursement for this code.  There was not yet an RVU value assigned to this billing code.

 

Our goal is to help with financial planning, given that the changes in reimbursement may have some effect on our clients’ overall collections.  We also hope that this will provide you great greater clarity in your documentation procedures, which should allow us to code to the highest level of specificity for the services that you’ve rendered, which maximizes reimbursement and minimizes compliance risk.

 

 

About Apache Health

Apache Health is a revenue cycle management (RCM) analytics, benchmarking, and auditing company. The founders of Apache formerly ran a large RCM company that was acquired by a private equity group in a rollup. Apache’s predictive analytics will benchmark billing performance and project exactly how much more revenue you should earn from your existing volume of patients.  Using many factors and a blend of artificial intelligence and specialty specific benchmarks, the model projects whether changing the billing process would improve collections for your particular mix of procedures and payers. Apache Health can help you evaluate whether to outsource the billing, determine which billing company to select to maximize performance, or track in-house billing performance improvement over time. For more information contact:

Sean McSweeney

Apache Health

www.apachehealth.com

888-422-5514