Wiki Kyphoplasty Dx

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KristinM522

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Our Medicare billing rep is saying our kyphoplasty procedures are being denied when used with the compression fracture dx (S codes), that we have to use the osteoporosis or malignant related fractures. This change to the LCD was effective in July. I guess I have been living under a rock!

Is this true??
 
Your wires are crossed. A compression fracture ICD.10 code does not start with an "S". Those codes are for "Traumatic" fractures. A compression fracture is non-traumatic. Your diagnosis will start with "M".
 
Sorry for the confusion in my wording. Let me give you an example of our most recent denial. This was on an older patient who tripped and fell backwards resulting in a wedge compression fracture, we used dx S32.010A and are being denied. She is saying we can only use one of the dx codes listed below, but none of these fit the patients condition.
ICD-10 Code​
Description​
M80.08XAAge-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture
M80.08XSAge-related osteoporosis with current pathological fracture, vertebra(e), sequela
M80.88XAOther osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture
M80.88XSOther osteoporosis with current pathological fracture, vertebra(e), sequela
ICD-10 Code​
Description​
C41.2*Malignant neoplasm of vertebral column
C79.51*Secondary malignant neoplasm of bone
C79.52*Secondary malignant neoplasm of bone marrow
C90.00*Multiple myeloma not having achieved remission
C90.01*Multiple myeloma in remission
C90.02*Multiple myeloma in relapse
M84.58XAPathological fracture in neoplastic disease, other specified site, initial encounter for fracture
M84.58XSPathological fracture in neoplastic disease, other specified site, sequela
 
What you need to find out is "Is this a pathological fracture"? A pathological fracture is when a bone breaks due to disease process such as osteoporosis and cancer. If this is an older patient the chances are good that this is a pathological fracture meaning that the bone probably broke due to the underlying disease, and probably would not have broken otherwise. People fall all the time for various reasons without causing fractures. I think this is where you need to start.
 
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