New codes effective for the year 2012

20527 Injection, enzyme (eg, collagenase), palmar fascial cord (ie, Dupuytren’s contracture)

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22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interpace (other than for decompression), single interspace and segment; lumbar

22634 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; each additional interspace and segment

CPT code 20930 was revised to include placement of osteopromotive material as one of the types of material used in the procedure. It now reads “+20930—Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure).”

Additionally, CPT code 20931 was revised to reference its applicability in spine surgery only. It now reads “+20931—Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure).” Both 20930 and 20931 may be used in conjunction with codes 22319, 22532, 22533, 22548–22558, 22590–22612, 22630, 22800–22812, 0195T, and 0196T.

Refer to the CPT manual for guideline changes related to CPT codes 22851, 63075, and 63076, as well as a cross-reference following CPT code 22614. A key change to CPT code 22851 is the deletion of the reference to threaded bone dowels, which are now reported with CPT code 20931.

New codes
Two new codes—22551 and 22552—continue the trend of moving away from component coding in spine surgery to the use of a more comprehensive code. Based on the frequency of reporting of anterior cervical discectomy/decompression procedures with an anterior interbody fusion procedure, the following new code and an add-on code were introduced for the cervical spine when both procedures are performed at the same site, same setting:

  • 22551—Arthrodesis, anterior interbody, including disk space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2
  • +22552— Arthrodesis, anterior interbody, including disk space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2, each additional interspace (List separately in addition to code for separate procedure)

The guideline instructions for CPT codes 63075 and 22554 instruct the surgeon to not report the two codes together when both procedures are performed at the same site and the same level during the same session.

Beginning in 2011, surgeons are required to code the initial level ACDF as 22551 and each additional level as 22552. Use of the operating microscope in microdissection for the cervical decompression remains bundled with these codes.

The older codes 63075 and 22554 were not deleted since they still can be performed in isolation, and the arthrodesis code 22554 also may be used with code 63081 for anterior cervical corpectomy.

There was also an editorial change applied to code 22851 for placement of an interbody prosthetic device. The previous parenthetical example of a threaded bone dowel was removed in order to clarify that machined bone allografts are described with code 20931 for use of structural bone allograft.

The nonstructural bone allograft code 20930 now describes use of either morselized bone allograft or other osteopromotive material for spine surgery. This change was meant to clarify the use of code 20930 for use of such materials as bone morphogenetic protein and demineralized bone matrix.

With the deletion of 61795, there are three new CPT codes to describe the physician work of image-guided navigation. When performing stereotactic computer- assisted navigation for intradural cranial surgery, the neurosurgeon should report code 61781. For stereotactic computer-assisted navigation used in extradural cranial surgery such as nasal sinus surgery, the surgeon should report code 61782. Performance of
stereotactic computer-assisted navigation for spinal surgery should be reported with code 61783.

Lastly, a new code set was developed for surgery to distinguish cranial nerve neurostimulator and generator placement from that of the vagal nerve. When performing both the placement of a cranial nerve neurostimulator electrode and generator, code 64568 is reported. Removal of the electrode and generator is reported with code 64570. If the stimulator electrode array is revised or replaced, code 64569 is reported. Open placement of a vagal nerve stimulator electrode remains coded 64573, whereas the placement of the generator is reported with either 61885 or 61886.

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