Quick Coding Tips for Vertebroplasty and Kyphoplasty

Quick Coding Tips for Vertebroplasty and Kyphoplasty

When reporting vertebroplasty, 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 vertebral body treated:

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

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

For each additional vertebral body treated during the same session, report one unit of add-on code 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). 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 nonetheless should select a single “initial level” code.

For example, a surgeon documents bilateral percutaneous vertebroplasty at vertebral segments T12 and L1. Proper coding is 22510, 22512.

Note that 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.

Watch for Bundles

Percutaneous vertebroplasty codes include the two procedures most commonly performed during the same session—imaging guidance and bone biopsy (e.g., Biopsy, bone, trocark or needle; deep (eg, vertebral body, femur)—and therefore you may not code seperately for them at the same level. If the provider 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.

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

Kyphoplasty Is Like Vertebroplasty “Plus”

Percutaneous vertebral augmentation (a.k.a., kyphoplasty or balloon-assisted percutaneous vertebroplasty) is a similar to vertebroplasty, but includes the use of an inflatable balloon to “jack up” the damaged vertebra(e) prior to methylmethacrylate injection. To distinguish kyphoplasty from “standard” vertebroplasty look for evidence in the documentation for a mechanical device to augment vertebral height prior to injection of methylmethacrylate/poly methylmethacrylate bone cement, such as:

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

CPT® includes three 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)

Code 22513 describes the initial vertebral body as treated in the thoracic area. Code 22514 describes the initial vertebral body as treated in the lumbar area. Select only one “initial” level (either 22513 or 22514). For each additional vertebral body treated, beyond the first, report one unit of add-on 22515. Additional coding rules mimic those we applied, above, for vertebroplasty:

  • Code descriptor for 22513-22515 specify “unilateral and bilateral;” therefore, modifier 50 is not appropriate
  • Do not apply modifiers 51 or 59 to the 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 with 22513-22515 with 22310, 22315, 22325, or 22327, when perform at the same level
  • Moderate sedation is included with 22513-22515

Note that no CPT® Category I or Category III codes describe cervical kyphoplasty. To report cervical kyphoplasty, turn to 22899 Unlisted procedure, spine.

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John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

About Has 404 Posts

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

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