Spine code changes you can’t afford to miss

By Paul Cadorette, CPC, COC, CPC-P, COC, CASCC, Director, Training and Education, Coding, and Alison Kuley, CPC, Senior Spine Coder, National Medical Billing Services for Becker’s ASC Review

Much like the spine itself, medical coding constitutes the backbone of your revenue cycle. As more spinal procedures are performed on an outpatient basis in ambulatory surgery centers, minimizing surgical coding compliance errors is critical to sustainable revenue capture.

In the first half of 2022, experts have noticed a significant spike in errors related to two new spinal procedure codes in ASCs. But because these code errors have not yet been widely discussed, ASCs have not moved broadly to correct the issues. Correcting assumptions and misunderstandings regarding these new spinal codes can help ASCs ensure coding accuracy on these high-cost procedures.

Decompression for Stenosis Code Update

Laminectomy and spinal interbody fusion are two increasingly popular outpatient procedures commonly performed at ASCs. In general, these surgeries can be performed separately or in conjunction with each other, depending on the patient’s needs. In the past, ASCs were instructed to use spinal codes 63047 and 63048 to describe decompression of the neural elements when performed in conjunction with interbody fusion procedures.

Because the interbody fusion codes included minimal laminectomy to prepare the interbody space for fusion, decompression codes 63047 and 63048 were bundled into CPT codes 22630-22634. The modifier code 59 was then needed to indicate that the procedure was performed separately from making the approach and was intended for complete decompression due to stenosis.

Many carriers felt that the laminectomy codes were a part of the interbody fusion, even though the description of 22630-22634 states “other than for decompression.” Physicians, on the other hand, believed that there was a need to perform complete and separate decompression on the nerves due to severe stenosis at those levels and attempted to code accordingly.

The solution was to introduce a new set of spinal codes specifically for decompression when performed at the same interspace as interbody fusion. These new codes are:

• 63052: Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of the spinal cord, cauda equina and/or nerve root(s) [for example, spinal or lateral recess stenosis]), during posterior interbody arthrodesis, lumbar; single vertebral segment (list separately in addition to code for primary procedure).
• 63053: Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s) [for example, spinal or lateral recess stenosis]), during posterior interbody arthrodesis, lumbar; each additional vertebral segment (list separately in addition to code for primary procedure).

While these new codes have solved one problem, they have introduced a few new ones.

How to Properly Use New Spine Codes

Both new codes, 63052 and 63053, are designated as add-on procedures to CPT codes 22630-22634. Here’s an easy way to think about it:

• Use the new codes (63052 and 63053) when: Your ASC performs decompression of neural elements at the same level(s)/interspace as lumbar interbody fusion.
• Use the old codes (63047 and 63048) when: Your ASC performs only a decompression procedure for spinal stenosis.

At first glance, this may feel like a distinction without a difference. But the reality is that mistakenly coding 63052 or 63053 for a standalone decompression procedure could be a costly error. That’s because 63052 and 63053 are add-on codes that would not be reimbursed by themselves.

Correcting Spine Code Errors

Generally, errors regarding these new spinal codes have occurred because of misunderstandings regarding their purpose. For example, many have assumed that 63052 and 63053 have replaced the 63047 and 63048 codes. This assumption is untrue but easily corrected.

The solution comes down to knowledge and training–ensuring that staff know that 63047 and 63048 should still be used for lumbar decompression procedures when performed independently. This distinction should be made on a vertebrae-by-vertebrae basis.

Optimizing Your Revenue Cycle and Patient Care

Ultimately, these code changes will not have a significant impact on direct patient care. However, ensuring your ASC staff are minimizing code errors by conducting routine coding assessments and continuing education can have a direct impact on your overall revenue cycle.

Coding is complex and being wrong can be costly.  Eliminating errors can help ensure your ASC’s revenue cycle backbone remains strong and in good health.