Radiology Coding Alert

Seniors suffer from nearly 700,000 fractures every year, and as baby boomers age, the number of fractures will only increase. Interventional radiologists are starting to rely on a relatively new therapy called vertebroplasty, so it's time to get used to the ins and outs of coding this highly effective procedure. New Way to Treat Compression Fractures Vertebroplasty is used to treat painful compression fractures that are unresponsive to other medical treatment, says Richard Duszak Jr., MD, interventional radiologist at The Reading Hospital and Medical Center in Reading, Pa. It is also performed in cases of vertebral metastases, myeloma and traumatic fractures although its effectiveness in patients with chronic compression fractures (greater than 6-12 months old) is limited and may be associated with increased risks in patients with associated spinal stenosis. Vertebroplasty is considered a relatively noninvasive procedure (or minimally invasive procedure) since it does not require a surgical incision. An interventional radiologist or neuroradiologist usually performs the procedure. "In our experience," Duszak says, "both local anesthesia (00600-00670) and conscious sedation (99141) are used in most patients."

Under radiological guidance, a cocktail straw-size needle is placed in the affected vertebra. Medical-grade bone cement (PMMA) is slowly injected into the compressed vertebra. The cement typically hardens within about 15 minutes, Duszak says, but it may take up to an hour for each vertebra injected. Ninety percent of the patients undergoing this procedure experience relief within 24 hours. The procedure, which stabilizes the fractured bone, may even prevent further damage if performed in time. "A large majority of patients with acute and subacute vertebral compression fractures will have substantial or complete pain relief shortly after percutaneous vertebroplasty some even immediately after the procedure," Duszak tells RCA. Coding Vertebroplasty Until 2001, no code for this procedure existed. Now there are three procedure codes from which to choose: CPT 22520 Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic CPT 22521 ... lumbar +CPT 22522 ... each additional thoracic or lumbar vertebral body [list in addition to code for primary procedure]. There are also two guidance codes for vertebroplasty fluoroscopic and CT: 76012 (Radiological supervision and interpretation, percutaneous vertebroplasty, per vertebral body; under fluoroscopic guidance) and 76013 (... under CT guidance). Coding should include a radiological and a surgical code. Vertebroplasty is, however, distinguished from conventional surgical procedures in that it is minimally invasive, Duszak says. In most circumstances, vertebro-plasty can be done as an outpatient, and many centers discharge their patients a couple hours after treatment. Medical necessity should be clearly documented and reveal the patient's pertinent history, including failed attempts for medical management. Medicare does not consider this procedure covered as a prophylactic measure or to treat chronic pain. Some examples of [...]