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Vertrobroplasty VS Vertebral Augementation

  1. Default Vertrobroplasty VS Vertebral Augementation
    Medical Coding Books

    We are having a discussion in our organization regarding the difference between CPT code 22520 - Vetebroplasty and 22523 - Vertebral Augmentation.

    We believe this should be coded as a 22523, but AMA is indicating the documentation does not appear to constitute a cavity creation and should be coded as a 22520. We feel the physician created the void with the AVAflex needle. Does anyone have any input on this? Thanks for your help.

    The procedure is as follows:

    Procedure: L1 vertebral augmentation and stabilization with methylmethacrylate using AVAflex system. Description of Procedure: Incision was made with a #11 blade through sine, subcutaneous tissue, fown to the level of the fascia. Usuing an AVAflex needle via an extrapedicular approach, the T11 vertebral body was entered with good medialization, thus a unilateral approach was choosen. The needle was advanced to the midportion of the T11 vertebral body. The bone appeared to be somewhat firm. Due to the retropulsed componenet, it was opted not to place a balloon, but to use a curved needle to perform the vertebral augmentation. The use a curved needle to perform the vertebral augmentation. The inner stylet of the needle was removed and a curved needle was advanced to about 2 mm into the midportion of the L1 vertebral body, and then an internal osteotomy was performed with good void formation, advancing the needle 2 - 3 mm up to approximately 5 mm, formation, with good void formation. At this point, methylmethacrylate then was prepared in the usual fashion in the AVAmax cement delivery gun. This was hooked to the curved needle and the methylmethacrylate was delivered, approximately 4 mL, into the L1 vertebral body, with good filling of the void and interdigitation on both sides. Methylmethacrylate was allowed to set. Then the curved needle and AVAmax needle were removed. Final AP and lateral x-rays showed good filling of the fracture with stabilization. There was mild reduction of the fracture noted as well. There was no extravasation into the venous system or canal. The wound was irrigated with sterile normal saline solution and closed in a physiologic fashion with 4 -0 subcuticular stitch and Dermabond for the skin edges

  2. Default
    Sorry but I agree that this should be 22520. In the neurosurgical coding companion in the description of code 22523 it states that balloon catheters need to be used. From the description of the OR, balloons were not used which is a big part of the kyphoplasty. This sounds more like a vertebroplasty, code 22520.

  3. #3
    Alexandria, LA
    Kyphoplasty requires the use of a "mechanical device" for cavity creation - a needle does not qualify.
    (I'd also ask which level was this done on - you have L1 in some places and T11 in others - codes would be different depending on which it was.)

  4. #4
    Yes,it should be coded as Vertebroplasty as we find documentation stating ballons are not opted(Moreover its not clear on the level as T11 OR L1).

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