Orthopedic Coding Alert

You can report the professional component for your surgeon's services.

If your surgeon performs vertebroplasties, a refresher on how to report radiological assistance your surgeon utilized will help you ace these claims. (For more on coding biopsies with vertebroplasties, see Orthopedic Coding Alert, Vol.15 No.3).

Know When to Append Modifier 26

When doing a percutaneous vertebroplasty, your surgeon will use imaging for positioning the needle or to assess the injection technique. You report the radiological supervision with codes 72291 (Radiological supervision and interpretation, percutaneous vertebroplasty, vertebral augmentation, or sacral augmentation [sacroplasty], including cavity creation, per vertebral body or sacrum; under fluoroscopic guidance) or 72292 (Radiological supervision and interpretation, percutaneous vertebroplasty, vertebral augmentation, or sacral augmentation [sacroplasty], including cavity creation, per vertebral body or sacrum; under CT guidance) depending upon whether your surgeon uses computed tomography (CT) instead of fluoroscopic guidance.

You append modifier 26 (Professional component) if the procedure is performed in a facility setting. "This has been historically separately reportable to account for circumstances in which the imaging interpretation is performed by a separate physician, typically a radiologist, from the physician performing the vertebroplasty. Based on trends in CPT®, the services may become bundled if a significant majority of both services are performed by the same physician," says Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison.

Caveat: "If you append modifier 26, you must save a hard copy of the image(s), and you must dictate a separate procedural report, and sign it (or electronically sign it) separately," says Bill Mallon, MD, medical director, Triangle Orthopedic Associates, Durham, N.C.

Coding example: "If your surgeon performs vertebroplasty at T12 and L1 and uses fluoroscopic guidance, you report codes 22520 (Percutaneous vertebroplasty [bone biopsy included when performed], 1 vertebral body, unilateral or bilateral injection; thoracic), 72291-26 and +22522 (Percutaneous vertebroplasty [bone biopsy included when performed], 1 vertebral body, unilateral or bilateral injection; each additional thoracic or lumbar vertebral body [List separately in addition to code for primary procedure])," says Heidi Stout, BA, CPC, COSC, PCS, CCS-P, Coder on Call, Inc., Milltown, New Jersey and orthopedic coding division director, The Coding Network, LLC, Beverly Hills, CA.

"Modifier 26 would be added for the provider's claim unless the provider owned the fluoroscopy equipment," says Kristi Stumpf, MCS-P, CPC, COSC, ACS-OR, owner, Precision Auditing and Coding, senior orthopedic coder & auditor, The Coding Network, Washington. "If the equipment is physician owned, the full work value would be reported. CPT® codes 72291 and 72292 both carry a PT/TC indicator of "1", indicating that the procedures have both a technical and professional component."

If your payer is Medicare, watch for the edit for radiological supervision services. "CPT® codes 72291 and 72292 are to be reported per segment. Medicare has an unlikely edit of "3" for the radiological supervision services -- keep an eye out for this restriction for your Medicare carriers," says Stumpf.

Tip: You append modifier 26 to the appropriate radiology service code to show that the surgeon provided only the physician component of the service. Do not report the radiological service if your surgeon did not personally perform the guidance. The healthcare professional involved in the guidance actually bills for the service.