Neurosurgery CPT Codes Updates for 2017

As the New Year is quickly approaching, it is time to explore the CPT® updates that can impact your neurosurgery practice. A coder knows that neurosurgery coding is complex and that it demands great attention for even the minutest of the details—even more now as we gear up for another challenging year. Here are some CPT® updates that will majorly affect the way you code for neurosurgery:

Imaging Guidance in Spinal Interlaminar Injections

The principles that guide interlaminar injection coding are:

  • Anatomical localization of the injection in the spine.
  • Use of imaging guidance for the procedure.

For interlaminar injections of therapeutic or diagnostic substances, you can choose form the following codes depending upon the spinal region where the injection is administered:

62320 Injection(s), of therapeutic or diagnostic substance(s) (for example: anesthetic, opioid, steroid, antispasmodic, other solution), not including neurolytic substances, including catheter placement or needle, interlaminar epidural or subarachnoid, thoracic or cervical; without imaging guidance.
62322 Sacral (caudal) or lumbar; without imaging guidance.

The codes for when the physician administers interlaminar injections using imaging guidance, are:

62321 Injection(s), of therapeutic or diagnostic substance(s) (for example, anesthetic, opioid, steroid, antispasmodic, other solution), not including neurolytic substances, including catheter placement or needle, interlaminar epidural or subarachnoid, thoracic or cervical; with imaging guidance (fluoroscopy or CT).
62323 Sacral (caudal) or lumbar; with imaging guidance (fluoroscopy or CT).

The codes for when the physician administers interlaminar therapeutic or diagnostic substance by continuous infusion or intermittent bolus, are:

62324 Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of therapeutic or diagnostic substance(s) (for example anesthetic, opioid, steroid, antispasmodic, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, thoracic or cervical; without imaging guidance.
62325 Thoracic or cervical; with imaging guidance (fluoroscopy or CT).
62326 Sacral (caudal) or lumbar; without imaging guidance.
62327 With imaging guidance (fluoroscopy or CT).

Prepare to Specify Location for Percutaneous Cryoablation of Nerves

CPT® 2017 will bring new codes for percutaneous cryoablation of peripheral nerves. The relevant code has to be selected by looking at the anatomical location of the cryoablation.

For nerves in the upper and lower extremities:

0440T Ablation, percutaneous, cryoablation, includes imaging guidance; upper extremity distal/peripheral nerve.
0441T Ablation, percutaneous, cryoablation, includes imaging guidance; lower extremity distal/peripheral nerve.

For percutaneous cryoablation of a plexus or nerves in the trunk:

0442T Ablation, percutaneous, cryoablation, includes imaging guidance; nerve plexus or other truncal nerve (for example: brachial plexus, pudendal nerve).

New Codes for Spinal Device Procedures

Below are some new codes that CPT® 2017 has also added for interspinous, intervertebral, and interlaminar biomechanical and stabilization spinal devices:

22853 Insertion of interbody biochemical device(s) (synthetic cage, mesh) with integral anterior instrumentation for device anchoring (screws, flanges), when performed, to interverbal disc space in conjugation with interbody arthrodesis, each interspace.
22854 Insertion of intervertebral biochemical device(s) (synthetic cage, mesh) with integral anterior instrumentation for device anchoring (screws, flanges), when performed, to vertebral corpectomy(ies) (vertebral body resection, partial or complete) defect, in conjunction with interbody arthrodesis, each contiguous defect.
22859 Insertion of intervertebral biochemical device(s) (synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect.
22867 Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level.
22868 Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; second level.
22869 Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; single level.
22870 Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; second level.

New Code for Endoscopic Decompression of the Lumbar Spine

With all these changes, CPT® 2017 will also include a new code for endoscopic decompression of the lumbar spine.

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). However, you should note that this code is inclusive of laminotomy, facetectomy, foraminotomy, and discectomy.

For more insights on the CPT® changes that you might expect in 2017, attend this Webinar by expert speaker Gregory J. PrzybylskiMD., who is a Professor of Neurosurgery at Seton Hall University and Interim Chairman of the NJ Neuroscience Institute at JFK Medical Center. You will also learn about the effective use of modifiers to obtain appropriate reimbursement for neurosurgical procedures.

 

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