2024 Spine Coding Changes for ASCs: Your Questions Answered!
Now available on demand! Watch our webinar Master 2024 Spine Code Challenges for an in-depth discussion on ASC spine coding policy changes.
Welcome back, spine coding enthusiasts! With so many 2024 spine coding changes for ASCs, our recent Master 2024 Spine Code Challenges webinar included a live Q&A session, packed with audience questions.
Although our coding experts couldn’t get to every question in real time, Paul Cadorette and Alison Kuley compiled the remaining queries here.
Let’s pick up where they left off and dive straight into the answers you’ve been eagerly awaiting!
Q: Are technologies like Inspan, Aurora Zip, Stabilink also coded with 22899 like was discussed with Minuteman?
A: Yes, these are various manufacturers of spinous process fusion devices that are all coded as unlisted per 2012 CPT Assistant and 2023 CPT Knowledge Base (revisit webinar slides 17-18 for more information).
Q: What are the coding guidelines for the instrumentation used in spine procedures (ex Magec Rod)? standard mark-up ASCs should consider when billing implants?
A: According to CPT Assistant, December 2022, Volume 32, Issue 12 – code 22899 (Unlisted procedure, spine) can be reported for musculoskeletal surgeries utilizing adjustable spinal magnetic growing rods. Here’s more information from CPT Assistant:
Currently, there is no specific CPT code available to report the implantation of adjustable spinal magnetic growing rods. Therefore, code 22899, Unlisted procedure, spine, may be reported for this service. When reporting an unlisted code to describe a procedure or service, it is necessary to submit supporting documentation (eg, a procedure report) along with the claim to provide an adequate description of the nature, extent, and need for the procedure, and the time, effort, and equipment necessary to provide the service.
Q: I think it was mentioned that Catamaran was considered an intra articular SI Fusion. All the publications I’m able to find state that this is a transfixing device. Can you provide insight?
A: We talked about “interpretation” and that two people can look at the same body of text and come away with different interpretations of that material. This is an example of that. While the device manufacturer may recommend 27279 because of their interpretation of what transfixing means, the Catamaran is a device that is placed directly into the SI Joint. By definition, that makes this an intra-articular implant coded with 27278.
Q: What’s the best practice for coding sacrectomy?
A: Best strategy would be unlisted code for this one. The sacrectomy is performed in the removal of malignant tumors, so if that were the case, I don’t see where the sacrectomy would be a separate and distinct service for reporting
Q. Does the ability to append modifiers to unlisted codes extend to Category III CPT codes?
A: It’s plausible that modifiers may need to be appended to Category III codes. For example, you may need modifier -59 to show a distinct procedural service, modifiers 73/74 should the procedure be discontinued, or laterality modifiers RT/LT. We’d still recommend that you track payment when appending modifiers to Category III codes as carrier policies may differ.
Q. What can you tell us about the Minuteman device?
A: The device has a small “barrel” in the center for bone graft placement and a clamp on either side. It is placed in between the spinous process and attached to the spinous process on either side by the clamps for stabilization. Per CPT these devices are coded as unlisted (see webinar slides 17-18 for more information).
Q: When billing CPT 22899 for some of these cases, what codes would you recommend for the comparison codes when it comes to RVU and pricing?
A: For percutaneous fusion you could compare to 22612. For spinous process plates/clamps, this service would have many of the same procedural components as 22869. For intra-facet implants, you can look at 22853 (which is not on the Medicare list, but you could compare to payment from another commercial payer).
Q: What is the website for the Medicare approved ASC procedures?
A: The ASC Payment Rates website lists the Medicare approved ASC procedures. Always confirm that you are using a link related to the CMS website (https://www.cms.gov) when searching for Medicare related information (see a screenshot below).
Q: Endoscopic codes are not covered by most private insurances. Do you have advice on keeping track of that and how to manage it for endoscopic procedures?
A: Aside from reviewing your managed care contracts terms or contacting payer representatives for clarification on endoscopic procedures, you can verify insurance coverage and eligibility for each patient prior to the procedure to see if the codes are covered. This also helps you provide patients with a more accurate cost estimate upfront. Cost is particularly useful for the patient to know if you discover an endoscopic service is a noncovered service.
You can also monitor reimbursement expectations by developing a contract matrix for all payers. List your individual carriers and state whether or not the carrier will reimburse for each endoscopic code. You can then use this information to track your progress on each case and each payer. If a payer will not reimburse for the procedure, you can let the physician know not to expect payment on that case. You’ll also need to contact the patient to alert them to the fact that this is a noncovered service under their insurance plan and arrange for patient payment.
Q: Since unlisted codes do not receive facility payment from Medicare, do you have suggestions as to how to receive facility reimbursement?
A: Our recommendation is to issue an Advanced Beneficiary Notice of non-coverage (ABN). Contact the patient to let them know that the service is a noncovered service under Medicare. The patient needs to know that they are responsible for payment and what the estimated cost for the service(s) would be. You can also explain your ASC’s available payment options.
Q: Do you have suggestions on how to get AMA responses published in the CPT assistant?
A: Unfortunately, we don’t. There are many questions that we as an organization have submitted to the AMA and we wish that the responses were published, but that rarely happens.
Q: Are there any published resources that specially say the OLLIF is an unlisted code?
A: Yes – CPT Assistant June 2020 (see webinar slide 12 for more information).
Q: For SI Joint Fusion – what about 0775T?
A: This code has been deleted for 2024 and replaced with CPT code 27278 (see webinar slide 22 for more information).
Q: What is your best guidance for documenting further laminectomy beyond what is required to prepare the interspace during a lumbar interbody fusion 22633?
A: Documenting the decompression of neural structures such as bony stenosis or removal ligamentum flavum hypertrophy that is compressing the nerve. If this is done, then you’d be justified in reporting a decompression code.
Q: What is the proper code for an inter laminar device used for fixation of a fusion?
A: Unlisted code 22899 (see webinar slides 17-18 for more information).
Q: Our group has been told that to meet “transfixing” for SI Fusions, there is NO directional. Is this correct?
A: CPT Assistant defines “transfixion” as placement if internal fixation device passes through the ilium, across the sacroiliac joint, and into the sacrum (see webinar slide 21 for more information).
Q: Inspan, ZIP, Stabilink are all accessed posteriorly, not laterally. Would those fit the 22612 if they go out to the lateral aspects of the facets?
A: Inspan and Stabilink are very similar to the Minuteman spinous process device. These devices are still considered spinous process fusion devices and per CPT Assistant coded as unlisted (see webinar slides 17-18 for more information).
