ASC Payment: Ride the Ups and Downs of New CPT® 2017 Spine Codes

Fri, Feb 10, 2017 --

CPT Codes

spine illustration

Ambulatory surgical centers (ASCs) are their own special animal, and discovering which procedures Medicare will cover in an ASC can take some investigation. Here’s a look at the ASC fee schedule data for the spine codes CPT® added in 2017.

Keep in mind: This information applies to Medicare. You may be able to negotiate different rules with private payers.

No Joy for Biomechanical Device Insertion Codes

CPT® 2017 introduced three new add-on codes for biomechanical device insertion:

  • +22853 for insertion of interbody biomechanical device(s) (e.g., synthetic cage, mesh) in conjunction with interbody arthrodesis
  • +22854 for insertion of intervertebral biomechanical device(s) (e.g., synthetic cage, mesh) in conjunction with interbody arthrodesis
  • +22859 for insertion of intervertebral biomechanical device(s) (e.g., synthetic cage, mesh, methylmethacrylate) without interbody arthrodesis.

History: These codes replace now-deleted code 22851 (Application of intervertebral biomechanical device[s] [e.g., synthetic cage(s), methylmethacrylate] to vertebral defect or interspace [List separately in addition to code for primary procedure]). In 2016, Medicare listed 22851 as excluded from payment in ASCs.

No separate payment: Medicare’s 2017 ASC addendum AA lists the payment indicator for all three new add-on codes as N1, which means “Packaged service/item; no separate payment made.”

Tip: The primary service codes paired with these add-on codes may be reportable in the ASC. For example, CPT® lists 63030 as one of the possible primary codes for +22853. Medicare’s 2017 payment rate for 63030 is $2,651.09.

Find a Mixed Bag for 22867-22870

CPT® 2017 also introduced four new codes for insertion of lumbar interlaminar/interspinous process stabilization/distraction devices: 22867-+22870. These codes replace now-deleted codes 0171T and +0172T (Insertion of posterior spinous process distraction device [including necessary removal of bone or ligament for insertion and imaging guidance], lumbar …).

In 2016, the Medicare ASC rate for 0171T was $7,886.65. (Add-on code +0172T wasn’t listed.)

Separate payment for some: Primary codes 22867 and 22869 have payment indicator J8, which means “Device-intensive procedure; paid at adjusted rate.” The final payment rate for each is $10,521.55.

The add-on codes +22868 and +22870 have indicator N1, which, as mentioned above, means there is no separate payment because the service is packaged.

Size Up the New Rate for Endoscopic Lumbar Decompression

A final new CPT® 2017 code for the spine is 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).

In 2016, this endoscopic decompression would have been best represented by an unlisted procedure code.

Separate payment: In 2017, the payment indicator for 62380 is J8, so it’s priced as a device-intensive procedure. The rate is $3,574.44.

What About You?

Do you code for ASCs? Do you tend to agree with Medicare’s list of covered procedures?

About 

Deborah concentrates on coding and compliance for radiology and cardiology, including the tricky world of interventional procedures, as well as oncology and hematology. Since joining The Coding Institute in 2004, she’s also covered the ins and outs of coding for orthopedics, audiology, skilled nursing facilities (SNFs), and more.

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