Plus, know that you should not report fluoroscopy with facet injections
As per CPT® 2012, you will see a variation in the guidelines for instrumentation for spinal procedures. Below is a quick refresher on the novel instrumentation revisions.
What is new in 2012? The review for CPT® 2012 in spinal instrumentation states that you will simply use the insertion code when your surgeon carries out a removal with variation of instrumentation in overlapping spinal levels. You apply this even though your surgeon performs the insertion at new levels when an overlap exists with the previously instrumented segments.
2 key changes: While you are reporting spinal instrumentation in 2012, ensure you apply the following revisions:
1. You must not report CPT®code 22849 (Reinsertion of spinal fixation device) for reinsertion of instrumentation and codes 22850 (Removal of posterior nonsegmental instrumentation [e.g., Harrington rod]) -22855 (Removal of anterior instrumentation) meant for removal of instrumentation along with the insertion codes +22840 (Posterior non-segmental instrumentation [e.g., Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation] [List separately in addition to code for primary procedure]) as well as +22848 (Pelvic fixation [attachment of caudal end of instrumentation to pelvic bony structures] other than sacrum [List separately in addition to code for primary procedure]).
2. Once your surgeon inserts new instrumentation at levels beside previously instrumented segments and also gets rid of or revises the earlier placed instrumentation in the same session for instance there is an overlap between the originally placed instrumentation and the recently placed instrumentation, you only report the correct insertion code (+22840-+22848). You will not report the reinsertion (22849) or removal (22850, 22852 [Removal of posterior segmental instrumentation], and 22855) procedures besides the insertion of the new instrumentation (+22840-+22848).
Avoid Reporting Fluoroscopy Along with Facet Injections
Question: Your provider bills the following:
As per CPT® 2012, you will see a variation in the guidelines for instrumentation for spinal procedures. Below is a quick refresher on the novel instrumentation revisions.
What is new in 2012? The review for CPT® 2012 in spinal instrumentation states that you will simply use the insertion code when your surgeon carries out a removal with variation of instrumentation in overlapping spinal levels. You apply this even though your surgeon performs the insertion at new levels when an overlap exists with the previously instrumented segments.
2 key changes: While you are reporting spinal instrumentation in 2012, ensure you apply the following revisions:
1. You must not report CPT®code 22849 (Reinsertion of spinal fixation device) for reinsertion of instrumentation and codes 22850 (Removal of posterior nonsegmental instrumentation [e.g., Harrington rod]) -22855 (Removal of anterior instrumentation) meant for removal of instrumentation along with the insertion codes +22840 (Posterior non-segmental instrumentation [e.g., Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation] [List separately in addition to code for primary procedure]) as well as +22848 (Pelvic fixation [attachment of caudal end of instrumentation to pelvic bony structures] other than sacrum [List separately in addition to code for primary procedure]).
2. Once your surgeon inserts new instrumentation at levels beside previously instrumented segments and also gets rid of or revises the earlier placed instrumentation in the same session for instance there is an overlap between the originally placed instrumentation and the recently placed instrumentation, you only report the correct insertion code (+22840-+22848). You will not report the reinsertion (22849) or removal (22850, 22852 [Removal of posterior segmental instrumentation], and 22855) procedures besides the insertion of the new instrumentation (+22840-+22848).
Avoid Reporting Fluoroscopy Along with Facet Injections
Question: Your provider bills the following:
- 64493 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral; single level) -50 (Bilateral procedure)
- 64494 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral; second level [List separately in addition to code for primary procedure]) -50 (Bilateral procedure)
- 27096 (Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance [fluoroscopy or CT] including arthrography when performed) -59 (Distinct procedural service) RT and 27096 -59 LT
- 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, or subarachnoid])
- J1030 (Injection, methylprednisolone acetate, 40 mg)
Payers are negating 64493 as being redundant to 77003. How can you get 64493 paid while billing 77003? Can you add a modifier to 77003?
Answer: The fluoroscopic guidance code is not reportable along with the injection codes, which bundle the image guidance once fluoroscopy or CT imaging is used. The CPT 2012 changes bundle imaging guidance in 27096 (Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance [fluoroscopy or CT] including arthrography when performed), whereas 64493 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral; single level) and 64494 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral; second level [List separately in addition to code for primary procedure]) already included fluoroscopy.
You must not bill separately for 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, or subarachnoid]) when reporting these injection CPT codes. Moreover, you should not append -59 (Distinct procedural services)
Source URL :- http://www.supercoder.com/coding-newsletters/my-neurosurgery-coding-alert/2012-update-apply-these-new-instrumentation-updates-for-spine-surgery-110566-article
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