Radiology Coding Alert

Understanding the kyphoplasty/vertebroplasty distinction is crucial You can set yourself up for clean claims and stop expensive mistakes. The key: Know when to report vertebroplasty codes and when to report the three kyphoplasty codes introduced in 2006 instead.
 
Differentiate Vertebroplasty and Kyphoplasty Kyphoplasty (22523-22525) is similar to vertebroplasty (22520-22522), but the two are not identical, and you should not code them in the same way, says Eric Sandhusen, CHC, CPC, director of compliance with Columbia University in New York City.
 
During vertebroplasty, the radiologist injects methylmethacrylate (a cement-like substance) into one or more weakened vertebral bodies. When the substance hardens, it reinforces the bone and helps to relieve pain.
 
During kyphoplasty, as with vertebroplasty, the physician injects a cement material into the patient's vertebral bone to repair spinal fractures. But with kyphoplasty, the physician first inserts a balloon into the vertebral space and inflates it to help restore vertebral height (for this reason, some physicians refer to kyphoplasty as "balloon-assisted percutaneous vertebroplasty").
 
Helpful: Kyphoplasty actually restores vertebral height and reduces deformity (kypho means "hump"), whereas vertebroplasty strengthens existing bone and prevents further deterioration. Pay Attention to Spinal Level There are three kyphoplasty and three vertebroplasty codes. The spinal level on which the radiologist performs the procedure determines which code you'll report, covering thoracic, lumbar, and each additional thoracic or lumbar vertebral body.
 
Vertebroplasty: Report the following codes for vertebroplasty, says Stacy Gregory, RCC, CPC, in her Coding Institute audioconference, "Optimum Reimbursement for Non-Vascular Interventional Radiology":
 
• CPT 22520 -- Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic
 
• 22521 -- ... lumbar
 
• +CPT 22522 -- ... each additional thoracic or lumbar vertebral body. Kyphoplasty: The kyphoplasty codes mirror the vertebroplasty code descriptors. The new codes describe "percutaneous vertebral augmentation including cavity creation, fracture reduction, and bone biopsy if performed," Gregory says:
 
• 22523 -- Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, one vertebral body, unilateral or bilateral cannulation (e.g.,kyphoplasty); thoracic
 
• 22524 -- ... lumbar
 
• +22525 -- ... each additional thoracic or lumbar vertebral body.

Kyphoplasty tip: During kyphoplasty, as with vertebroplasty, the physician injects a cement material into the patient's vertebral bone to repair spinal fractures. But with kyphoplasty, the physician first inserts a balloon into the vertebral space and inflates it to help restore vertebral height (for this reason, some physicians refer to kyphoplasty as "balloon-assisted percutaneous vertebroplasty").

Verify Your Payer's Rules Red flag: The rules for coding vertebroplasty services can be confusing. The CPT Editorial Panel opinion (as reflected by CPT Assistant March 2001, Volume 11, Issue 3) and the Society of Interventional Radiology opinion (as reflected by the Interventional Radiology Coding Users' Guide) differ from Medicare instructions.
 
Medicare: When reporting [...]