Anesthesia Coding Alert

Question: My physician performed a bilateral kyphoplasty, and I billed 22523 with modifier 50, but the claim was denied. Isn't it a bilateral procedure? Tennessee Subscriber Answer: You would normally append modifier 50 (Bilateral procedure) when a procedure is performed bilaterally. Kyphoplasty (22523-22525, Percutaneous vertebral augmentation, including cavity creation [fracture reduction and bone biopsy included when performed] using mechanical device, one vertebral body, unilateral or bilateral cannulation [e.g., kyphoplasty] . . .), however, happens to be one of those tricky CPT codes that is already bilateral in nature. In fact, that component is built right into the code description. Therefore, you should not append modifier 50 to kyphoplasty procedures, such as 22523. The same rule applies to the other kyphoplasty codes: 22524 -- ... lumbar +22525 -- ... each additional thoracic or lumbar vertebral body (list separately in addition to code for primary procedure). Also consider: During kyphoplasty, the specialist injects bone [...]