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Orthopedic Coding Alert

You Be the Coder:

What's Going on With LADR Payment?

What's Going on With LADR Payment? Question: We haven't had much luck getting authorization to perform LADR on our Medicare patients. Does Medicare approve this procedure? Kansas Subscriber             Answer: Medicare does cover lumbar artificial disc replacement (LADR), but only under very specific circumstances, and not for patients older than 60 years of age. When CPT 2007 introduced 22857 (Total disc arthroplasty [artificial disc], anterior approach, including discectomy to prepare interspace [other than for decompression], lumbar, single interspace), many orthopedic practices felt that they would see enhanced LADR coverage, but last month Medicare announced that LADR is -not reasonable and necessary for the Medicare population over 60 years of age.- Therefore, you won't be able to collect for this high-cost surgery unless your patient is 60 or younger. If your LADR patient is 60 or younger, you should find out how your carrier wants you to code this service, because Medicare does not publish a national coverage guideline. In general, however, you-ll report 22857 for the first LADR interspace. When the physician performs LADR on more than one lumbar interspace, report +0163T (Total disc arthroplasty [artificial disc], anterior approach, including discectomy to prepare interspace [other than for decompression], lumbar, each additional interspace) for each additional interspace.
For example, your surgeon performs a lumbar arthroplasty at three separate interspaces. On the claim, you should report the following: 22857 for the first interspace 0163T x 2 for the other two interspaces.


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