Solidify Your Vertebroplasty and Kyphoplasty Coding

Solidify Your Vertebroplasty and Kyphoplasty Coding

New codes distinguish between the two spinal surgeries, and bundle additional services.

By G.J. Verhovshek, MA, CPC

Percutaneous vertebroplasty is a minimally invasive procedure during which the surgeon injects “bone cement” (methyl methacrylate) into a vertebra(e) to fill vertebral fractures and restore spinal integrity. Percutaneous vertebral augmentation (a.k.a., kyphoplasty or balloon-assisted percutaneous vertebroplasty) is a similar procedure adding  the use of an inflatable balloon to jack up the damaged vertebra(e) prior to methyl methacrylate injection. Proper coding for vertebroplasty and kyphoplasty requires distinguishing between the two procedures and recognizing bundled services commonly performed during the same encounter.

Choose One Primary
Code for Vertebroplasty 

CPT® 2015 provides three new codes to describe vertebroplasty:

22510 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic

22511 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; lumbosacral

+22512 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; each additional cervicothoracic or lumbosacral vertebral body (List separately in addition to code for primary procedure)

Code selection depends on the location and number of vertebral bodies treated. Choose a single initial level code based on the location of the first treated vertebral body (22510 cervicothoracic or 22511 lumbosacral). For each additional vertebral body treated during the same session, report one unit of add-on code 22512. Note that codes 22510-22512 describe unilateral or bilateral procedures. Do not append modifier 50 Bilateral procedure (or expect additional reimbursement) if the physician injects the same vertebral body multiple times.

For example, the patient has fractures of the second, third, and fourth lumbar vertebrae (L2, L3, and L4). The physician applies a local anesthetic, places the needle over L2, and injects methyl methacrylate bilaterally to fill the fracture. He repeats the process at L3 and L4. Report 22511 for the initial lumbosacral level and 22512 x 2 for the additional lumbosacral levels. Do not append modifier 51 Multiple procedures or modifier 59 Distinct procedural service to the add-on code describing the additional levels.

If the physician treats multiple spinal levels, beginning in the cervicothoracic region and crossing into the lumbosacral region, you should select a single “initial level” code. For example, osteoporosis, a common condition for which physicians use percutaneous vertebroplasty, often occurs at the thoracic/lumbar junction. If the surgeon treats the final thoracic vertebra (T12) and the first lumbar vertebrae (L1), you would report 22510 or 22512 (not 22510, 22511).

Know What’s Bundled

Percutaneous vertebroplasty codes 22510-22512 include the two procedures most commonly performed during the same session — imaging guidance and bone biopsy — and therefore you may not code separately for them.

Regarding bone biopsies, CPT® specifically prohibits reporting 20225 Biopsy, bone, trocar or needle; deep (eg, vertebral body, femur) with 22510-22512 when performed at the same level. If the physician performs bone biopsy at a level not addressed by the vertebroplasty, you may report the biopsy separately with modifier 59 appended to indicate the separate locations of the two procedures.

Percutaneous vertebroplasty includes moderate sedation, and may not be reported with fracture care codes 22310, 22315, 22325, or 22327 when performed at the same level.

Kyphoplasty Includes an Extra Lift

During kyphoplasty (percutaneous vertebral augmentation), the surgeon first creates a working space within the fractured vertebral body, and then places a mechanical device (e.g., an inflatable bone tamp (IBT)) in the enlarged cavity. The bone tamp is inflated to restore height to the damaged vertebral body and then removed. The resulting cavity is filled with bone cement.

To distinguish kyphoplasty from standard vertebroplasty, look for evidence in the documentation for a mechanical device to augment vertebral height prior to injection of methyl methacrylate/poly methyl methacrylate bone cement, such as:

  • Balloon
  • Balloon-assisted
  • Bone tamp
  • IBT
  • KyphX® (a common brand name for the bone tamp)

CPT® 2015 includes three new codes to describe kyphoplasty, which mirror the vertebroplasty codes:

22513 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic

22514 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; lumbar

+22515 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure)

Vertebroplasty Rules
Apply to Kyphoplasty Codes

Select kyphoplasty codes based on the segment of the spine treated. Code 22513 describes the initial vertebral body treated in the thoracic area. Code 22514 describes the initial vertebral body treated in the lumbar area. Select only one initial level (either 22513 or 22514). For each additional vertebral body treated, report one unit of add-on code 22515.

For example, if the surgeon documents kyphoplasty at T10, T11, and L1, report 22513, 22515 x 2.

Additional coding rules also mimic those for vertebroplasty:

  • Codes 22513-22515 specify unilateral and bilateral; modifier 50 is not appropriate.
  • Do not apply modifier 51 or 59 to add-on code 22515.
  • Do not report bone biopsy (20225) performed at the same level(s) as kyphoplasty.
  • Imaging guidance is included with 22513-22515.
  • Do not use 22513-22515 with 22310, 22315, 22325, or 22327 when perform at the same level.
  • Moderate sedation is included with 22513-22515.
  • No CPT® Category I or Category III codes describe cervical kyphoplasty. To report cervical kyphoplasty, turn to 22899 Unlisted procedure, spine.

G.J. Verhovshek, MA, CPC, is managing editor at AAPC and a member of the Asheville-Hendersonville, North Carolina, local chapter.

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Renee Dustman

Renee Dustman

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.
Renee Dustman

About Has 425 Posts

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.

3 Responses to “Solidify Your Vertebroplasty and Kyphoplasty Coding”

  1. Kathy C says:

    Our patient was diagnosed with a vertebral fracture in June/2015. Patient then underwent Kyphoplasty in July/2015.
    The carrier denied the Kypho as global to the fracture
    We sent in a corrected claim using modifier -78
    The carrier is denying stating inappropriate modifier?
    When I called to find out why, the rep stated she didn’t know why and that I would need to appeal!
    I am going to appeal but my question; the modifier -78 is correct? Am I allowed to put a modifier on this code?

    Thanks so much for your time and attention!

  2. ASaiz says:

    Thank you for your comment. You’ll find a lot of suggestions and better answers to your question in the Member Forums.

  3. Melissa S says:

    Is there a special way we should be coding for a kyphoplasty with a KIVA implant? My doc wants to bill as 22513 with 22851? I have been trying to do a little investigating on this but I am not coming up with any other coding scenario. Please help.

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