Part B Insider (Multispecialty) Coding Alert

Published on Thu Sep 22, 2005 PDF

But existence of new CPT codes doesn't mean you'll get paid

After  years of waiting, you’ll finally have three codes for reporting kyphoplasty starting in January.

The codes cover thoracic (22523), lumbar (22524) and each additional thoracic or lumbar vertebral body (22525). Until now, you’ve used an unlisted code for this procedure, in which the surgeon creates a cavity to open up the spine.

These new codes mirror the existing codes for percutaneous vertebroplasty, which surgeons actually perform less often, says Heidi Stout, coding and reimbursement specialist with University Orthopedic Associates in New Brunswick, NJ. The technique is different for thoracic and lumbar kypho
plasty, because you’re dealing with different levels of the spine, she notes.

Warning: The additions don’t mean you’ll get paid for kyphoplasty, cautions Jeff Fulkerson, a certified coder for the department of radiology at The Emory Clinic in Atlanta. The majority of carriers still view kyphoplasty as an experimental, non-covered procedure. But now that there are codes, it’s easier to force the issue.

Bonus: The 2006 CPT Updates also adds a new code for extracorporeal shock wave therapy  involving the plantar fascia (28890). For the past three years, you’ve had to use a Category III code (0020T) for this procedure, and most payors wouldn’t recognize it, laments Mary Brown, coder with OrthoWest in Omaha, NE.

“This surgery is for patients who have failed all other forms of conservative treatment for plantar fasciitis,” Brown explains. Patients are put under general anesthetic, and the physician applies a special gel to the heel and the treatment head of the instrument, which then delivers shock waves.

CPT 2006 also deletes codes 21493-21494 for closed treatment of hyoid fracture. And the update adds two codes for open incision and drainage of a deep abscess (subfascial) in the posterial spine (22010-22015).