Work Your Way Through This Vertebroplasty Coding Example

Thu, Mar 16, 2017 --

CPT Codes

coding for vertebroplasty

When you think of all the bits and pieces a spine includes, it’s no surprise coding for spine services can get complicated. Today we’ll tackle this tough subject by walking through an example from Orthopedic Coding Alert.

Here’s the example: The operative note shows bilateral vertebroplasty at vertebrae T10, T11, T12, L1, and L2.

Which CPT® codes should you report?

Narrow Your Options to Vertebroplasty Codes

CPT® includes vertebroplasty and vertebral augmentation (like kyphoplasty) in the sequence 22510-+22515.

Codes 22510-+22512 are specific to percutaneous vertebroplasty:

  • 22510-+22512, Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance

Codes 22513-+22515 apply to percutaneous vertebral augmentation:

  • 22513-+22515, 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

Our example says the case involves vertebroplasty, limiting us to 22510-+22512, but determining which spine stabilizing procedure is involved in a real case may be more difficult. Keep these pointers in mind:

  • Vertebroplasty: The provider injects bone cement into the fractured vertebra.
  • Vertebral augmentation: The provider injects bone cement into the fractured vertebra after augmenting the vertebral height, which typically involves using a balloon catheter to create a cavity for the bone cement, often polymethylmethacrylate (PMMA). Terms like balloon, inflatable bone tamp, balloon-assisted percutaneous vertebroplasty, and kyphoplasty may point you to 22513-+22515.

Add Your Code Options

Now that you’ve narrowed your code options to 22510-+22512 for vertebroplasty, the time has arrived to choose the codes — and units — specific to the case.

Report one unit of 22510 (… cervicothoracic) for the primary thoracic level T10.

For the two additional thoracic levels (T11 and T12) and the two lumbar levels (L1 and L2), you should report a total of four units of add-on code +22512 (… each additional cervicothoracic or lumbosacral vertebral body [List separately in addition to code for primary procedure]).

Be sure to catch that you reported a single primary code even though the service involved both the thoracic and lumbar spinal regions.

Note that this coding also follows two important rules established by the code descriptors:

  • Each code unit represents one vertebral body
  • Each code is appropriate regardless of whether the service is unilateral or bilateral, so you should not append modifier 50 (Bilateral procedure) or report double the units for a bilateral service.

How About You?

What terms help you determine which of these codes to report?

About 

Deborah concentrates on coding and compliance for radiology and cardiology, including the tricky world of interventional procedures, as well as oncology and hematology. Since joining The Coding Institute in 2004, she’s also covered the ins and outs of coding for orthopedics, audiology, skilled nursing facilities (SNFs), and more.

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2 Comments For This Post

  1. jitendra Says:

    very informative post Deborah….when i was coding interventional radiology i have lot of confusion in coding kyphoplasty and verterbroplasty….this article really enhances my skills in coding vertebroplasty..thanks for sharing…!!!

  2. Deborah Marsh Says:

    Thanks, Jitendra! Interventional radiology is a really interesting specialty – so many different body systems and so many new procedures to learn and understand.

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