Neurosurgery Coding Alert

When reporting 22520-22522 or 22523-22525, you won't code separately for bone biopsy (20225, Biopsy, bone, trocar or needle; deep [e.g., vertebral body, femur]) if the biopsy occurs at any of the same spinal levels as the primary procedure. The CPT code descriptors stipulate this limitation, as do many payer local coverage determinations (LCDs). In addition, national Correct Coding Initiative (CCI) edits bundle bone biopsy to vertebroplasty and kyphoplasty codes.

But if the neurosurgeon should perform bone biopsy at a level not addressed by the vertebroplasty or kyphoplasty, you may report the biopsy separately with modifier 59 (Distinct procedural service) to indicate the unrelated nature and separate locations of the two procedures. Several payers further direct you to -identify the site (such as L1) [of the biopsy] in item 19 of the CMS-1500 form or its electronic equivalent.-

Example: The neurosurgeon performs kyphoplasty at L2 and L3, with bone biopsy in a separate area, such as L5. In this case, you may report 22524 and 22525 (for the kyphoplasty) plus 20225-59 for the deep bone biopsy at a different location.

Had the biopsy occurred at L2 and/or L3, however, it would be bundled to the kyphoplasty, and you could not report it separately.