Increase Payment for New Percutaneous Vertebroplasty Codes
Published on Thu Feb 01, 2001
The introduction of percutaneous vertebroplasty codes in CPT 2001 has created excitement for a great number of neurosurgeons who now feel encouraged that they can get reimbursed for this procedure. However, billing for this, particularly during the current crosswalk period (in which carriers are still formulating specific policies regarding new codes) presents a challenge.
The number of new codes may be limited, but the potential problems are not, says Anita Day Foster, MA, CPC, V.P. of the Coding Network, a network of experienced coders that provides services to academic environments in Beverly Hills, Calif. Gaining reimbursement for percutaneous vertebroplasty hinges on the proper use of the main procedure code and add-on codes, knowledge of diagnosis codes, and a firm understanding of documentation requirements and use of modifiers.
Coding for Percutaneous Vertebroplasty
Percutaneous vertebroplasty is an interventional neurosurgical procedure consisting of an injection of methyl methacrylate (a cement-like substance) into one or more weakened vertebral bodies to provide pain relief and bone strengthening. The procedure is performed under fluoroscopic guidance, although some neuro-surgeons prefer the use of computed tomography (CT) with fluoroscopy for needle positioning and injection assessment.
Until CPT 2001, neurosurgeons who performed this procedure were directed by Medicare to use 22899 (unlisted procedure, spine), but, instead, many billed with 64999 (unlisted procedure, nervous system) or 62287 (aspiration or decompression procedure, percutaneous, of nucleus pulposus of intervertebral disk, any method, single or multiple levels, lumbar [e.g., manual or automated percutaneous diskectomy, percutaneous laser diskectomy]) which was inappropriate. The misuse of 62287 was one of the main reasons new codes were created.
The new vertebroplasty procedural codes include:
22520 (percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic);
22521 ( lumbar); and
+22522 ( each additional thoracic or lumbar vertebral body).
There are also two new codes that have been created for the needle positioning and injection assessment portion of the procedure. They are:
76012 (radiological supervision and interpretation, percutaneous vertebroplasty, per vertebral body; under fluoroscopic guidance); and
76013 ( under CT guidance).
Donald H. Frank, senior partner of the Neurosurgical Group of New Jersey in Montclair, and a clinical instructor at New York University says the neurosurgeon should only code for the fluoroscopic (76012) or CT guidance (76013) associated with percutaneous vertebroplasty if he or she personally performed the guidance. Otherwise, the healthcare professional who provided it should bill.
Multilevel Coding
He also states that a neurosurgeon may perform this procedure at one or more thoracic and lumbar levels during the same session.
Osteoporosis, one of the common conditions that warrants the use of percutaneous vertebroplasty, can occur anywhere on the spine, but most often happens at the thoracic-lumbar junction, Frank reports. The bones [...]
