Orthopedic Coding Alert

Crossing spinal regions calls for more than one -primary level- code If you can't tell percutaneous vertebroplasty (vertebroplasty) from percutaneous vertebral augmentation (kyphoplasty), your coding will suffer. The solution? Focus on documentation details rather than easily confused and often misleading terminology. Step 1: Know the Difference When deciding between kyphoplasty (22523-22525) and vertebroplasty (22520-22522) codes, look for evidence that the orthopedist inserted an inflatable bone tamp into the vertebral space. During both kyphoplasty and vertebroplasty, the orthopedist injects bone cement (methylmethacrylate) into a fractured vertebral body to fill the fracture and restore spinal stability.

Vertebroplasty and Kyphoplasty Codes CPT lists three vertebroplasty and three kyphoplasty codes. The vertebroplasty codes cover thoracic, lumbar and each additional thoracic or lumbar vertebral body, as indicated in the code descriptors: - 22520 -- Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic
- 22521 -- - lumbar
- +22522 -- - each additional thoracic or lumbar vertebral body (list separately in addition to code for primary procedure). The kyphoplasty descriptors follow the same pattern as the vertebroplasty descriptors: - 22523 -- Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechani- cal device, one vertebral body, unilateral or bilateral cannulation (e.g., kyphoplasty); thoracic - 22524 -- - lumbar - +22525 -- - each additional thoracic or lumbar vertebral body (list separately in addition to code for primary procedure). Note that all of the above codes apply to either unilateral or bilateral procedures. You would not append modifier 50 (Bilateral procedure) or expect additional reimbursement if the orthopedist injected the same vertebral body on each side.
Both are percutaneous procedures that often require only local anesthesia, and both procedures strengthen existing bone to prevent further deterioration. Only kyphoplasty, however, includes using a balloon to augment (if not fully restore) vertebral height prior to the injection, says Jennifer Schmutz, CPC, with Neurosurgical Associates LLC in Salt Lake City. As such, some orthopedists may refer to kyphoplasty, or vertebral augmentation, as "balloon-assisted percutaneous vertebroplasty." Tip: You can often identify kyphoplasty by searching the operative note for the words "balloon," "bone tamp," "KyphX" (a common brand name for the bone tamp) or "IBT" (for "inflatable bone tamp"). Step 2: Choose Primary Code by Location When reporting either vertebroplasty or kyphoplasty, you must select a code to describe the "primary level" where the orthopedist performs the procedure, Schmutz says. CPT divides the procedures into thoracic and lumbar. For example, you should report 22520 as the "primary level" code for vertebroplasty at levels T1-T12 or 22521 for levels L1-L5. You would only ever report a single unit of 22520, a single unit of 22521, a single unit of 22523 or a single unit of [...]