Neurology & Pain Management Coding Alert

Question: The pain management physician completed a 3-level kyphoplasty with cavity creation (levels T11, T12, and L1) on a Medicare patient. I’ve heard some conflicting information lately on how to handle this type of coding. What do you recommend?

North Dakota Subscriber

Answer: Your claim to Medicare should include three codes:

·         22523 – Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, 1 vertebral body, unilateral or bilateral cannulation (e.g., kyphoplasty); thoracic

·         22525 – … each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure) 

·         22525-59 – Including modifier 59 (Distinct procedural service) to indicate a second injection to an additional level.

Explanation: The code sets for kyphoplasty and vertebroplasty each have a primary code and add-on codes for additional levels treated during the same operative session. For vertebroplasty, you first choose from 22520-22521 and add +22522 as appropriate. For kyphoplasty, the main codes are 22523-22524 and the add-on is +22525. The primary codes describe the injection; the physician’s approach, and closure; and the surgery’s global fee. The add-on codes cover the same service, but don’t include the associated global services that are part of the primary/parent codes.