Neurosurgery Coding Alert

Find out how you did answering the questions from the Coding Quiz

Did you conquer the coding challenge? Read on to find out.

Answer 1: False. The procedure described in this question is a kyphoplasty procedure, although some physicians refer to kyphoplasty as -balloon-assisted percutaneous vertebroplasty.- During both kyphoplasty and vertebroplasty, the neurosurgeon injects a cement material into the patient's vertebral bone to repair spinal fractures.
 
Both procedures are performed percutaneously, and often under only local anesthesia. During vertebroplasty, the surgeon introduces cement into the fractured vertebral body to fill any spaces and increase stability. Only kyphoplasty restores vertebral height.

Answer 2: B. CPT created three new kyphoplasty procedure codes for 2006. For lumbar kyphoplasty on a single level, you should report one unit of 22524 (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., kypho-plasty]; lumbar).
 
If the neurosurgeon performs a thoracic kyphoplasty, however, you should instead report 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).

For kyphoplasty procedures at each additional level, you-ll report +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]; each additional thoracic or lumbar vertebral body [list separately in addition to code for primary procedure]).

Code S2362 (Kyphoplasty, one vertebral body, unilateral or bilateral injection) was one of the two HCPCS codes that coders had to use for kyphoplasty procedures prior to Jan. 1, 2006, but this code has been deleted.

Answer 3: False. When your surgeon performs percutaneous vertebroplasty, you should select a single code to describe the primary level that the surgeon targeted. You-ll choose between 22520 (Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic) for levels T1-T12, and 22521 (... lumbar) for levels L1-L5.

If the neurosurgeon performs the vertebroplasty procedure at more than one spinal level during the same operative session, you should report each additional level using add-on code +22522 (... each additional thoracic or lumbar vertebral body [list separately in addition to code for primary procedure]), even if the additional level is in a different region.

Report the primary level using 22520 or 22521, and then use this add-on code for the subsequent levels. For example, if the surgeon injects methylmethacrylate into vertebral bodies L2, L3 and L4, you should report 22521 (for the first lumbar level) and 22522 x 2 (to represent the additional levels L3 and L4).

Note: You do not need to append modifier 51 (Multiple procedures) to 22522 because it is a designated add-on code and is not subject to a multiple-procedure fee reduction.

Answer 4: False. National Correct Coding Initiative version 12.0 bundles the new kyphoplasty codes (22523-22524) with several codes for spine computed tomography and fluoroscopy. But the bundles have a modifier indicator of -1.- This means you may use modifiers to break the bundles and report the two procedures separately if circumstances allow.

See the article -Don't Report Spine CT, Fluoroscopy With Kyphoplasty- in the February 2006 issue of Neurosurgery Coding Alert for the exact bundlings between 22523-22524 and the CT and fluoroscopy codes.

Answers for this quiz were reviewed by Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University department of surgery.