Case #7 Winner, Answer Key, & Rational

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Case #7 Winner, Answer Key, & Rationale

Diana B. is the winner of case #7. See below for the answer key and rationale.

CPT: 22514
CPT Modifiers: none
ICD-9: 733.13

The provider performs kyphoplasty on the L2 vertebrae to treat a compression fracture. There is no indication the fracture was traumatic so the diagnosis is reported as a pathologic fracture. Codes for kyphoplasty include the imaging guidance and is not reported separately.

CPT: 22514

Steps to look up: Kyphoplasty

ICD-9-CM: 733.13

Steps to look up: Fracture, pathologic/vertebrae
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Diana B. is the winner of case #7. See below for the answer key. We're working on the rationale and will have it posted shortly.

CPT: 22514
CPT Modifiers: none
ICD-9: 733.13

Coming soon.

Alex, can you please consider 22524? Sorry, I used the CPT 2014. I'll be using 2015 books on the next cases. Thank you.

Marissa Reyes, MD, CPC
Has the leader board been updated to reflect Case 7? I got it right, but still am only showing the 1 point that I had previously. Thank you.
I answered case 7 correctly but don't see that I received an additional point on leaderboard. Should have 4 points after case 7 vs 3. Don't want to be a pain but would like a shot at those awesome prizes.

Has the leaderboard been updated with case 7 answers yet?

Many Thanks
Maria, CPC, RHIT

Is 22514 a new code for 2015? I am using the 2014 cpt book, and 22514 is not listed. I used 22524.
Hi Everyone,

We're going to stick with the 2015 CPT book on this one. Sorry, coders.

Also, the leaderboard does not reflect case #7 scores. It can take up to 48 hours to get it updated.


Case #7 cpt 22514 (yes, a new 2015 cpt code)

Hello fellow AAPC coders,

Yes, cpt 22514 is a new 2015 cpt code

CPT 22514 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (e.g, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance ; lumbar

See link

Kyphoplasty: A modified percutaneous vertebroplasty is called as kyphoplasty. Kyphoplasty helps in treatment for Compression fractures by reducing the pain associated with osteoporotic vertebral compression fractures. The patient is placed in a prone, slightly flexed position. A 5 mm to 7 mm incision is made and small cannulas are inserted into the vertebral body from both sides. Balloon catheters, called "tamps," are inserted into the vertebra and inflated. The tamps create a void in the soft trabecular bone and restore vertebral alignment. The balloon is removed and bone cement is injected into the cavity.
Question regarding Case #7 answers

Case#7 answer(s) - CPT 22514, 733.13

733.13 Pathologic fracture of vertebrae

M48.56xA Collapsed vertebra, lumbar region, NEC, initial encounter for closed fracture

Hint: Case# 7 Vertebral compression fracture is the preoperative diagnosis so you’ll need your to know your modifiers and a very good look up tool for this one!

Case# 7

PREOPERATIVE DIAGNOSIS: Painful L2 vertebral compression fracture.

POSTOPERATIVE DIAGNOSIS: Painful L2 vertebral compression fracture.

NAME OF OPERATION: L2 kyphoplasty.


She had compression fractures at T 11 and L1, which underwent kyphoplasty and she initially had very good results, but then developed back pain once again. Repeat MRI a couple of weeks later showed that she had fresh high intensity signal changes in the body of L2 and some scalping of the superior end plate consistent with a compression fracture at L2. After some preoperative discussion and some evaluation to see if she would get better, she was admitted to the hospital for L2 kyphoplasty when she was not getting better.

At surgery, L2 had some scalping of the superior end plate. Most of the softness was in the back part of the vertebral body.


The patient was taken to the operating room and placed under general endotracheal anesthesia in a supine position. She was placed prone on the Jackson table and her back was prepped and draped in the usual sterile fashion. Timing biplane image intensifiers, the skin incision sites were marked out. 0.5k Marcaine with epinephrine was injected. Initially on the left side, a Xyphon trocar was passed down to the superior lateral edge of the pedicle and then passed down through the pedicle and into the vertebral body -uneventfully in the usual fashion. The drill was then placed into the vertebral body and then the Kyphon balloon tamp. In a similar fashion, the same thing was done on the other side. Balloons were then inflated uneventfully. The balloons were then deflated and removed and the cement when it was in the doughy state was then injected into the 2 sides in the usual fashion. This was done carefully and sequentially to make sure that there was no cement extrusions and in fact there were none, There was a good fill to the edges of vertebral body up towards the superior end plate and across the midline. The 'bone filling devices were then removed and the trocars removed, Pressure was applied after which the skin was sutured with 4-0 nylon. Sand-Aids were applied and she was taken to recovery in stable condition.


There were no complications. ESTIMATED BLOOD LOSS: Minimal blood loss.


Sponge and needle counts were correct.
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I also used the 22524, so I'm not sure what the global period is for 22514 and it doesn't say in my book - but 22524 only has a 10 day global period and in the note it said "a couple of weeks later" so I decided not to use modifier 78 as I assumed this procedure was outside of the 10 day global period.
22514 Has 10 global days.
I am looking at this just like the CPC exam... no payer specific guidelines to think about.
I didn't use global modifier because we were outside the ten day global period but wouldn't you use a modifier 76 for repeat procedure?
Since the documenation doesn't confirm the date of the first procedure, I did not assume the second procedure was performed during a global.