Long-awaited Codes Herald Payment for Vertebroplasty
Published on Sun Apr 01, 2001
New CPT Codes describing percutaneous vertebroplasty were introduced in 2001 an addition that was long overdue, according to radiology coding experts who point out that the procedure has been clinically accepted for years. Previously, vertebroplasty was reported with an unlisted procedure code and wasnt considered payable by many insurers.
A therapy developed to relieve pain and strengthen bones, percutaneous vertebroplasty is an interventional procedure where methyl methacrylate (a cement-like substance) is injected into weakened vertebral bodies. The procedure is performed under fluoroscopic guidance, although some radiologists prefer to use computed tomography (CT) with fluoroscopy for needle positioning and injection assessment.
Procedure and Guidance Codes Added
Jeff Fulkerson, supervisor of radiology billing at the Emory Clinic in Atlanta, explains that the new codes include two primary codes one for thoracic procedures and one for lumbar procedures plus an add-on code to describe additional levels treated. No code for cervical vertebroplasty was included in the 2001 additions. While the new codes pave the way for payment, Fulkerson says, reimbursement hinges on the proper use of the main procedure and add-on codes, and knowledge of diagnosis codes that support medical necessity.
The new vertebroplasty procedural codes include:
22520 percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic;
22521 lumbar; and
+22522 each additional thoracic or lumbar vertebral body.
In addition, CPT created two new codes to describe imaging, guidance and assessment of the injection:
76012 radiological supervision and interpretation, percutaneous vertebroplasty, per vertebral body; under fluoroscopic guidance; and
76013 under CT guidance.
Note: Many local carriers are finalizing their policies regarding vertebroplasty. It is anticipated that most will have these in place during April.
However, in the absence of local guidance, coders should check with carriers to determine if they should report the procedure with the previously accepted code, 22899 (unlisted procedure, spine). Another alternative may be 22899 with 76005 (fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint], including neurolytic agent destruction).
Fulkerson also notes that epidural venography (75872, venography, epidural, radiological supervision and interpretation) is often performed with vertebroplasty to assess blood flow characteristics within a vertebral body, and to evaluate the epidural space or the vertebral and paravertebral veins. Previously, it was thought that this service could be billed in addition to the procedure code, he says, but that is not the case. [...]
