Hello,
Just wanted to shed some light on these codes. Prior to July 1st, the codes that were used were 22899 (unlisted spinal procedure) or 64999 (unlisted nervous system procedure) with 22851. The 22851 represents the actual placement of the device, and has a relatively low reimbursement rate. 0091T was created to replace both the unlisted code and the 22851, and combines both the work involved and the placement of the device.
Unfortunately, the reason for the AMA creating what they call a "category III" code for the ADR is for research and tracking purposes. I spent some time on the phone with the AMA this morning, explaining the dilema that everyone is facing - there's an actual code of 0091T, but none of the insurance companies are recognizing it. I was told that it is up to the companies themselves to update their systems and review the info from the AMA website themselves. For anyone who has not read this info, please see the site below:
http://www.ama-assn.org/ama/pub/cate...885.html#0075T
I have also found that sending those pages from the AMA has helped (particularly with Workers Comp) to clarify the code for the insurance company.
I was also told that typically category III codes become full-fledged CPT codes at some point in time. The AMA will not release the latest list of "real" codes until November for 2006.
I find it very interesting that these are being coded as 63090. That code is for a vertebral corpectomy, which is the removal of part of the vertebrae and discs. As you all know, the ADR entails the removal of disc tissue, and is not the same as a 63090. In fact, I have seen the coding for an ADR patient who had both the ADR and a corpectomy at the same time, but they are not one and the same.
The good news is that there have been appeal denials overturned for the 0091T by Anthem BCBS, as well as private insurance companies and Workers Comp insurers.