R. Dale Blasier, MD
Coding Committee Chair
Many surgeons are performing procedures on the growing spine for Early Onset Scoliosis across the country, which includes VEPTR and growing rod procedures. These procedures, although mature and well-established, do not have their own CPT descriptors. As a result, surgeons have had to choose from existing codes which do not well-describe what is actually done during these procedures.
Because there are no codes which specifically describe these procedures, there are several problems: 1) There are not any standardized description or vignette which applies to these procedures 2) There is not a way to track the number of these procedures done across the country because there is no way to separate growing procedures from standard procedures as they use the same codes 3) It is not possible to track billing and reimbursement for procedures performed on children with early onset scoliosis.
As a result of these problems, the Scoliosis Research Society Coding Committee was tasked with determining whether new codes should be developed which specifically address non-fusion procedures performed on the growing spine. The goals for establishing new codes would be enabling tracking of these procedures, ensuring reimbursement and minimizing denials and to establish correct coding which accurately describes each procedure.
The issue was discussed by the Board of Directors during the 47th Annual Meeting in Chicago, Illinois, USA. It was determined that it would be appropriate to survey the SRS membership to determine satisfaction with the existing codes, determine which CPT codes are being used and assess the level of interest for the development of new codes.
The survey was created and circulated by email to North American members of the SRS in November of 2012. The survey asked if the member performed VEPTR or growing rod procedures and whether they used CPT codes to describe them. Members were asked if they felt they were fairly reimbursed for the procedures. The survey also sought to determine if the member felt there was a need to develop new codes to describe these procedures. Each member was also asked to describe which CPT codes would be used to describe procedures performed during the course of treatment including: 1) insertion, 2) revision, 3) lengthening and 4) removal. The questions were asked for both growing rod and VEPTR procedures.
There was a low rate of response to the survey. Forty three of 61 respondents (71%) used CPT codes to report VEPTR or growing rod procedures. Forty of 59 respondents (68%) favored changing the coding structure for these procedures.
Responses regarding VEPTR procedures:
Thirty two of 63 respondents (51%) performed VEPTR procedures. Only 26% (11 of 42) felt they were fairly reimbursed for their work.
The majority of respondents reported VEPTR insertion procedures using codes for insertion of segmental instrumentation. A smattering of respondents reported insertion of non-segmental instrumentation, unlisted procedures, or did not know what to use. For revision or reinsertion, the majority reported the use of 22849 (reinsertion of hardware) and 22850 (Removal of posterior non-segmental instrumentation). A smattering used an unlisted code or were not sure. For lengthening, almost all used the reinsertion code – 22849. For removal, most reported 22850 (removal of posterior non-segmental instrumentation) or 22852 (removal of posterior segmental instrumentation)
Responses regarding growing rod procedures:
Thirty six of 51 respondents (71%) performed VEPTR procedures. Only 40% (15 of 38) felt they were fairly reimbursed for their work.
The majority of respondents reported growing rod insertion procedures using codes for insertion of segmental instrumentation. A smattering of respondents reported insertion of non-segmental instrumentation, unlisted procedures, or did not know what to use. For revision or reinsertion, the majority reported the use of 22849 (reinsertion of hardware) sometimes with 22850 (removal of posterior non-segmental instrumentation). A smattering used an unlisted code or were not sure. For lengthening, almost all used the reinsertion code, 22849. For removal, most reported 22850 (removal of posterior non-segmental instrumentation) or 22852 (removal of posterior segmental instrumentation).
Problems with utilization of existing codes.
Correct Coding: There are several problems with using existing spinal instrumentation codes: 1) Spinal codes are being used in VEPTR cases in which the hardware does not make contact with the spine. 2) Hardware insertion codes are “add-on” codes and cannot be used in isolation without a “base” code such as arthrodesis. 3) The reinsertion code is being reported, even when no hardware is removed or inserted. 4) There is no agreement among users as to which codes to use. In short, the use of existing codes violates principles of correct coding.
Surgeon satisfaction: Sixty-eight percent of respondents favored changing the coding structure for these procedures. With regard to VEPTR procedures, only 26% of respondents felt they were fairly reimbursed for their work. With regard to growing rod procedures only 40% of respondents felt they were fairly reimbursed for their work.
The Development of new codes
It appears appropriate to proceed with developing a set of codes to describe growing rod and VEPTR procedures for the following reasons:
The current plan is to proceed with the development of relevant new codes for these procedures with the assent of the SRS Board of Directors. Member comments for or against this proposal can be sent to Brian Lueth (Blueth@SRS.org).
Committee Chair: R. Dale Blaiser, MD Committee Members: Jeffrey B. Neustadt, MD; Neel Anand, MD; Christopher J. DeWald, MD; Michael P. Chapman, MD; Mathew D. Hepler, MD; Nigel J. Price, MD.