ISASS Coding and Reimbursement Task Force: Recent Successes and Efforts

The ISASS Coding and Reimbursement Task Force leads ISASS efforts to advocate  for public and private payer policies, legislation, coding, and reimbursement for spine surgeons. The Task Force is led by Dr. Morgan Lorio, who also represents ISASS in multiple policy forums. Dr. James Yue is also a critical member of the Task Force, along with other key leaders and advisors.

Among the efforts that ISASS has led over the past 24 months are the following:

• Development and acceptance of multiple Current Procedural Terminology (CPT) code change proposals for new/revised CPT Category I and Category III codes related to spine surgery. Recent CPT activities include:
  • New CPT Category I codes for the following, effective January 2022:
    • Basivertebal nerve ablation
    • Lumbar decompression with TLIF/PLIF services (previously, decompression work when performed with TLIF/PLIF was not recognized)
  • The existing Category III code for lumbar total disc replacement, second level, converted to Category 1 code, effective January 2023. (ISASS made this proposal to the American Medical Association (AMA) CPT Editorial Panel, and it was approved at the fall AMA CPT Editorial Panel meeting.)
• Development and acceptance of a CPT code change proposal for dorsal SI joint arthrodesis
  • ISASS proactively requested a Category III code for the dorsal approach to differentiate it from 27279 and maintain the payment and intent of 27279.
    • ISASS worked with AAOS and AANS/CNS to develop a modified Category III code change proposal. Drs. Yue and Lorio, along with Dr. Domagoj Coric, presented it at the May 2022 CPT Editorial Panel meeting. The code change request was approved in early June and went into effect January 2023.
    • It will be converted to a category I code January 1, 2024.
  • Increased work relative value units (RVUs) for the 2022 Medicare Physician Fee schedule for CPT code 22867, “Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level.”
    • This code was flagged by CMS as “potentially misvalued” in 2020 based on written comments from ISASS asking for review and revaluation.
    • At the January 2021 AMA RVS Update Committee (RUC) meeting, ISASS, working with other surgical spine societies, recommended that the RUC recommend a higher work RVU for CPT code 22867.
    • The AMA RUC recommended an increase from the current work RVU of 13.50 to 15.00 based on ISASS recommendations.
    • CMS accepted the RUC-proposed increase in the 2022 Medicare Physician Proposed Rule, published July 2021.
    • ISASS submitted written comments and met with CMS via Zoom to request increased work RVUs above the recent increase.
  • Development and acceptance of a CPT code change proposal for a Category III code for a hybrid sacroiliac joint arthrodesis that combines the dorsal and lateral approaches.
    • Yue, Lorio, and others presented the category III code change proposal at the fall 2022 CPT Editorial Panel Meeting, where it was approved (effective July 2023).
    • Led a coalition of spine surgery societies (including the American Association of Neurological Surgeons/Congress of Neurological Surgeons [AANS/CNS], American Academy of Orthopaedic Surgeons [AAOS], Cervical Research Society [CRS], Scoliosis Research Society, and North American Spine Society [NASS]) to publish and disseminate a position statement on spine surgery by non-surgically trained specialties such as pain medicine.
      • Position statement has been well received and has been developed into state legislation in multiple states.
    • Requested deletion of Medicare Correct Coding Initiative (CCI) edits for new CPT codes for lumbar decompression for TLIF/PLIF procedures.
      • ISASS submitted a request in November 2021 to delete edits that would have not allowed payment for the new category I codes going into effect on January 2022.
      • ISASS, along with AANS/CNS, AAOS, and NASS, met with CMS in January 2021, and CMS deleted the proposed edit and allowed payment for the additional decompression.
    • Development and pending acceptance of a proposal for a series of new ICD-10-CM diagnosis codes for back pain and lumbar degenerative disc disease (LDDD).
      • No current ICD-10-CM diagnosis codes describe LDDD and back pain.
      • ISASS, working with AAOS and AANS/CNS, developed a request to the ICD-10-CM Maintenance Committee for a series of new ICD-10-CM codes.
      • Proposal was originally submitted in March 2021 and was updated and resubmitted in December 2022 in response to edits from the Maintenance Committee.
      • Lorio presented the request formally at the March 2023 Maintenance Committee Meeting.
      • If accepted, it will be published in 2023 and go into effect January 2024.

The Task Force contributions have led to many positive developments for Spine surgeons. The ISASS Coding and Reimbursement Task Force will continue to work diligently and in close collaboration with partner organizations.