Neurosurgery Coding Alert

Question: I came across the term “kyphoplasty” in my neurosurgeon’s medical documentation. Can you explain what happens during this procedure and which CPT^® codes I can choose from to report it?

 Alabama Subscriber

Answer: For a kyphoplasty procedure, using imaging guidance, the surgeon guides a balloon catheter (or other mechanical device) through a hollow needle inserted into the vertebra and inflates the balloon with a liquid under pressure, according to the CPT^® guidelines. Once the balloon is maximally inflated, the surgeon deflates the balloon and withdraws it, which leaves a cavity. The surgeon then fills this cavity with bone cement (typically polymethylmethacrylate). Surgeons commonly perform a kyphoplasty for a kyphosis or wedging of a persistently painful, fractured osteoporotic vertebra.

If your surgeon performs a vertebral fracture repair using cement via kyphoplasty, you can look to the following codes:

• 22513 (Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic)
• 22514 (… lumbar)
• +22515 (… each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure)). Note: You should report +22515 in conjunction with 22513 and 22514.

Don’t miss: “Percutaneous vertebral augmentation procedures (22513-+22515) are for the thoracic and lumbar areas only,” according to CPT^® Assistant Vol. 25, No. 1. “If cervical vertebral augmentation is performed, the unlisted CPT^® code (22899) should be reported.”

Caution: A kyphoplasty includes bone biopsies when performed and the imaging guidance necessary to perform the procedure, so you cannot report these services separately. Also, when submitting kyphoplasty claims, you should report only one primary procedure code and an add-on code for additional levels, even when thoracic and lumbar fractures are concurrently treated.