Published 12/31/2023
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Joanne S. Willer
This article previews relevant changes to the musculoskeletal section of the American Medical Association’s Current Procedural Terminology (CPT) Manual for 2024. For a full summary of changes, refer to Appendix B of the CPT Manual.
Three new codes have been created for anterior thoracic vertebral body tethering. These codes are used to report scoliosis correction without fusion using a tether (cord) to compress the vertebral growth plates on the convex side of the curve to inhibit their growth, while allowing the growth plates on the concave side of the curve to continue to grow. These codes may not be reported with anterior instrumentation codes 22845 to 22847. Please refer to the “Spine Deformity (eg, Scoliosis, Kyphosis)” section of the CPT Manual for guidelines and reporting instructions regarding co-surgeons. The new codes are:
- 22836, Anterior thoracic vertebral body tethering, including thoracoscopy, when performed; up to 7 vertebral segments
- 22837, 8 or more segments
- 22838, Revision (eg, augmentation, division of tether), replacement, or removal of thoracic vertebral body tethering, including thoracoscopy, when performed
With the establishment of these codes, revisions have been made to existing Category III codes for vertebral body tethering (0656T and 0657T), which clarify that their use is limited to the lumbar or thoracolumbar region of the spine. A new Category III code was also added to describe the work for revision, replacement, or removal of thoracolumbar or lumbar vertebral tethering: 0790T, Revision (eg, augmentation, division of tether), replacement, or removal or thoracolumbar or lumbar vertebral body tethering, including thoracoscopy, when performed.
CPT has established a code for reporting percutaneous arthrodesis of the sacroiliac (SI) joint using placement of an intra-articular implant without transfixation. This code replaces Category III code 0775T, which is now deleted. Additionally, instructions have been added for the reporting of hybrid percutaneous SI joint fixation. The new code is 27278, Arthrodesis, sacroiliac joint, percutaneous, with image guidance, including placement of intra-articular implant(s) (eg, bone allograft[s], synthetic device[s]), without placement of transfixation device.
The code descriptors for 28292 to 28297 (correction, hallux valgus) have been revised to clarify intentions for reporting bunion correction performed with and without bunion resection: 28292, Correction, hallux valgus with bunionectomy, with sesamoidectomy, when performed; with resection of proximal phalanx base, when performed, any method.
Note, codes in the family (i.e., 28295, 28296, 28297, 28298, and 28299) follow the same editorial revision as the parent code. A parenthetical note has also been added to code 28740 directing the user on appropriate use of the code.
A new set of guidelines has been added to CPT instructing users on the appropriate use of unlisted codes in conjunction with Category and Category III codes. The American Medical Association states that it is appropriate to report an unlisted code with a Category I or III code(s) for the same patient encounter on the same date of service when a separately reportable portion of the service provided is not described by an existing CPT code(s).
Furthermore, the guidelines do not preclude reporting of an appropriate code that may be found elsewhere in the CPT code set. It may be appropriate to report multiple Category I or Category III codes together to describe the totality of a service performed, provided each code represents a separately reportable service. Refer to the Unlisted Procedure or Service guidelines in the “Introductory” section of the CPT Manual for further guidance and coding examples.
Joanne S. Willer is the manager of coding and reimbursement resources in the AAOS Office of Government Relations.