Part B Insider (Multispecialty) Coding Alert

Published on Fri Aug 23, 2013 PDF

If you’re performing kyphoplasty, make sure you’re reporting the designated codes for this procedure and not higher-level spine surgery codes—or you could face massive penalties.

This was the lesson learned by a Long Island, NY orthopedic surgeon who recently paid the government $388,000 to settle allegations that he violated the False Claims Act. The government alleged that the doctor knowingly submitted kyphoplasty claims to Medicare using CPT codes that were assigned to “more complicated surgeries, thereby inflating his Medicare reimbursements,” the Department of Justice noted in an Aug. 21 news release.

Reality: CPT includes three kyphoplasty codes (22523-22525), which you should bill based on the spinal site and the number of vertebral bodies treated. If the surgeon performs kyphoplasty and bills a code for spinal fusion or other non-kyphoplasty code, bring it to her attention that only the designated kyphoplasty codes apply to the surgery.