Watch for Bundles

Codes used for Percutaneous vertebroplasty include the two procedures frequently performed during the same session—imaging guidance and bone biopsy therefore you might not code individually for them at the same level.  If the medical provider performs bone biopsy at a level not addressed by the vertebroplasty, you may report the biopsy alone with the 59 modifiers appended to indicate the separate locations of the two procedures.

Additionally, percutaneous vertebroplasty includes moderate sedation, when performed, and may not be reported with fracture care codes 22310, 22315, 22325, or 22327 when performed at the same level.

Kyphoplasty Is Like Vertebroplasty additional lift

Percutaneous vertebral augmentation is similar to vertebroplasty but includes the use of an inflatable balloon to lift the damaged vertebra prior to methyl methacrylate injection.  To differentiate kyphoplasty from “standard” vertebroplasty look for evidence in the medical note for a mechanical device to augment vertebral height prior to injection of methyl methacrylate or polymethylmethacrylate bone cement, such as:

• Balloon

• Balloon assisted

• Bone tamp

• IBT or inflatable bone tamp

• KyphX (a common brand name for the bone tamp)

a) CPT (Category I or Category III codes describe cervical kyphoplasty. To report cervical kyphoplasty, turn to 22899 Unlisted procedure, spine) includes three codes to describe kyphoplasty, which mirror the vertebroplasty codes:

b) Code 22513 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed), using a mechanical device (e.g., kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; relating to the thorax.

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

d) Code 22515 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using a mechanical device (e.g., kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure)

e) Code 22513 describes the initial vertebral body as treated in the thoracic area. Code 22514 describes the initial vertebral body as treated in the lumbar area. Select only one first level (either 22513 or 22514). For each additional vertebral body treated, beyond the first, report one unit of add-on 22515. Additional coding rules mimic those we applied, above, for vertebroplasty:

f) Code descriptor for 22513-22515 specifies “unilateral and bilateral;” therefore, modifier 50 is not appropriate

g) Do not apply modifiers 51 or 59 to the add-on code 22515

h) Do not report bone biopsy (20225) performed at the same level(s) as kyphoplasty- Imaging guidance is included with 22513-22515

I) Do not use 22513-22515 with 22310, 22315, 22325, or 22327, when performing at the same level

J) Moderate sedation is included with 22513-22515.

k) Make sure that no CPT Category I or Category III codes describe cervical kyphoplasty. To report cervical kyphoplasty, turn to 22899

Bristol Healthcare Services is one of the leading medical billing and coding companies. We have been serving medical professionals for over twenty years, helping them increase their revenue and keep their cash flow consistent. Our medical coding services are all certified and continuously educated so that they are up to date on all changes in code sets. Further, the entire gamut of revenue cycle services is offered at cost-effective rates; practices can save up to 50% of costs.