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Coding tip: Properly code the X-STOP procedure for spinal stenosis of the lumbar spine

Ambulatory Surgery Reimbursement Update, August 21, 2007

The X-STOP procedure, which the FDA approved in November 2005, is an interspinous process decompression system used to relieve spinal stenosis symptoms of the lumbar spine in patients aged 50 or older.

Spinal stenosis is a narrowing in the spinal canal that carries nerves to the legs. As the space in the lower spine shrinks, the nerves are compressed. Patients must have undergone at least six months of failed conservative non-operative treatment prior to undergoing the procedure.

The X-STOP is a two-compartment assembly titanium implant that fits between the spinous processes of the lower lumbar spine. A surgeon can perform this procedure on one or two lumbar segments. The X-STOP is a minimally-invasive procedure, and usually requires only local anesthesia.

Prior to 2007, you used the unlisted CPT code 22899 to code this procedure. However, as of January 1, 2007, you should use New Technology CPT code 0171T for the first lumbar level. Enter "1" in the units field of the claim form, with diagnosis code 724.02 (lumbar stenosis). Use add-on CPT code 0172T for each additional lumbar level, but continue to use the number "1" in the units field regardless of the number of levels. CMS does not consider the use of an assistant surgeon medically necessary for this minimally-invasive procedure.

This tip is brought to you by Ellis Medical Consulting, Inc.

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