For cranial radio surgery medical coding, there is also a set of new codes that should be looked at. Previously, advice has been to use the former radio surgery codes 61793 for both cranial and spine applications. But now there is a specific pair of codes for a spinal radio surgery for the initial lesion. And then each additional lesion, the type of device that is used for the radio surgery is not specified in the sense that it does not change which code one would use for the radio surgery.
One disappointing consequence for the development of all of the radio surgery codes was that the recommendation of the RUC for the relative value units that was submitted to CMS was in rare circumstance, not accepted by CMS and lower values were published in Medicare as final rule.
There is a process for appealing that but that process occurs over the duration of the calendar year of 2009. And so, it is not likely that values which change for most if not all of this calendar year even if a compelling argument can be made with CMS to change the values towards and preferably at the level that was recommended by the RUC.
The percutaneous disc procedure that you see had some editorial language regarding not reporting that code with the new percutaneous aspiration code. And as you might imagine, there's a substantial amount of overlap between two percutaneous procedures that place the needle into the disc space. This would be fairly standard editorial language to preclude medical coding – a pair of codes that should be mutually exclusive.
Multiyear gap existed between the 63020 posterior cervical discectomy code and the 63030 posterior lumbar discectomy code. With the development of technology that allowed for endoscopically assisted approaches and minimally invasive approaches to discectomy, editorial language was change number of years ago to this family of codes for allowing use of an open code with both open and endoscopically assisted approaches.
However, when the CPT language was published, rather than going to the parent codes 63020 to include that language, it was placed on the second tier 63030 code. And so some payers as well as some surgeons wondered whether the some thing applied to the parent primary code 63020. So this was simply to correct that gap and demonstrate that it is applicable both to the posterior cervical as well as the posterior lumbar codes.
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