Neurosurgery Coding Alert

Be sure to report radiological guidance to capture the reimbursement you deserve

With the addition of three new kyphoplasty CPT codes in 2006, you should make sure you-re differentiating between percutaneous vertebroplasty and kyphoplasty. If you-re coding them the same way, you could be losing reimbursement you deserve and you could open yourself up to denials. Don't Confuse Vertebroplasty With Kyphoplasty Kyphoplasty (22523-22525) is similar to vertebroplasty (22520-22522), but the two are not identical, and you should not code them in the same way, says Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University Department of Surgery in New York.

During kyphoplasty, as with vertebroplasty, the surgeon injects a cement material into the patient's vertebral bone to repair spinal fractures. With kyphoplasty, the surgeon first inserts a balloon into the vertebral space and inflates it to help restore vertebral height (for this reason, some surgeons refer to kyphoplasty as -balloon-assisted percutaneous vertebroplasty-). It helps to remember that a kyphoplasty actually restores vertebral height and reduces deformity (kypho means -hump-), whereas vertebroplasty strengthens existing bone and prevents further deterioration.

There are three kyphoplasty and three vertebroplasty codes. The spinal level on which the neurosurgeon performs the procedure determines which code you-ll report. The vertebroplasty codes cover thoracic, lumbar and each additional thoracic or lumbar vertebral body as indicated in the code descriptors:

- 22520 -quot; Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic
- 22521 -quot; - lumbar
- +22522 -quot; - each additional thoracic or lumbar vertebral body (list separately in addition to code for primary procedure). The kyphoplasty codes mirror the vertebroplasty code descriptors:

- 22523--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); thoracic

- 22524---lumbar

- +22525--- each additional thoracic or lumbar vertebral body (list separately in addition to code for primary procedure). Choose Primary Vertebroplasty Code by Location When reporting percutaneous vertebroplasty, select a single code to describe the -primary level- where the surgeon performs the procedure. Code choices include 22520 (Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic) for levels T1-T12 or 22521 (... lumbar) for levels L1-L5. During the vertebroplasty, the surgeon injects methylmethacrylate (a cement-like substance) into one or more weakened vertebral bodies. When the substance hardens, it reinforces the bone and helps to relieve pain.

You should report only 22520 or 22521 during the same session, never both, says Patrick J. Cafferty, MPAS, PA-C, CHCO, president and CEO of Neurosurgical Associates of Western Kentucky, a neurosurgery and pain management group. Use Add-on Code for Multiple-Level Vertebroplasty If the surgeon performs vertebroplasty at more than one spinal level during the same operative session, report each additional level using [...]