Neurosurgery Coding Alert

Question: How should we report percutaneous vertebroplasty of a cervical vertebra? CPT contains codes for the thoracic and lumbar levels, but I can't find a code for the cervical levels.

New Jersey Subscriber Answer: Percutaneous vertebroplasty describes a procedure during which the surgeon injects methyl methacrylate (a cement-like substance) into one or more weakened vertebral bodies. When the substance hardens, it reinforces the bone and helps to relieve pain.

As you say, CPT provides percutaneous vertebroplasty codes 22520 (Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic) for levels T1-T12 or 22521 (... lumbar) for levels L1-L5, but no code to describe the same procedure for cervical vertebrae.

Before CPT added 22520-22522 in 2001, most payers recommended that coders report all vertebroplasty procedures using 22899 (Unlisted procedure, spine). Most payers still recommend this code for cervical vertebroplasty, but you should check with your payer prior to billing to be sure about individual guidelines.

Note: For complete information on using unlisted- procedure codes, see Neurosurgery Coding Alert, February 2004 ("No Code? No Problem: Here's How to Handle Those Pesky 'Unlisted-Procedure' Claims," p. 9).

When the surgeon treats "additional" levels in the cervical area, you are justified in reporting 22899. For example, for treatment to levels L4, L5 and C1, your claim should read: 22521, 22522, and 22899. The neurosurgeon's documentation should explain that 22899 represents an "additional level" in the cervical area.