# 22521 vs 22851



## moodymom (Jul 29, 2010)

Hoping someone can shed some light on this for me. My Surgeon is performing Vertebroplasty with Spinal Fusion surgery. I am torn between CPT codes:
22521: Percutaneous vertebroplasy @Lumbar....or
22851:Application of biomechanical device(METHYLMETHACRYLATE)to vertebral defect or interspace.

I want to bill 22851, just want to see who agrees..or not. 
any suggestions or articles would be great...thanks in advance


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## jdemar (Jul 29, 2010)

22521 is for the lumbar area, if that is the area the Dr. is doing, that is correct for a lumbar percutaneous vertebroplasty (Kyphoplasty)...injecting polymethylmethacrylate under fluroscopic guindance.

Spinal fusion...is Arthrodesis, the code for lumbar arthrodesis is 22612 to fuse 2  lumbar vertebrall bones together....so depending on how many the Dr. is fusing you may need to add the additional CPT code 22525 as needed.  You need to count the total number of total vertebrae involved and subtract (-) one.

You will also need to code any instrumention that is involved.


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## RebeccaWoodward* (Jul 29, 2010)

Based on what you've posted, I don't agree with 22851.  22851 is an "add on" code and requires a parent code; unless this was done but we still need a primary code since it can not be an "add on" for 22521.  I do tend to agree 22521 if this was indeed a percutaneous vertebroplasty.  It would probably help to see the op note since you've mentioned a fusion which may support an additional code to the 22521.


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## moodymom (Jul 29, 2010)

My surgeon is performing a posterior spinal fusion using bilateral pedicle screws
CPT: 22612,22614.. the pt has already had an incision made to perform the fusion.
here is part of the op note,

pedicle screws were placed in the body of L5,L4,L3 and L2 bilaterally.The patients bone quality is poor and therefore vertebroplasty was done through the pedicle screw injecting 1.5 methylmethacrylate through each screw.

I'm not that crazy about 22521 because it is Percutaneous,however another coder feels it is correct..Im leaning more towards 22851..let me know what u think : ) thanks


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## RebeccaWoodward* (Jul 29, 2010)

Based on this, I agree with you...22851 rather than 22521

Intervertebral biomechanical device(s) such as synthetic cage(s), threaded bone dowel(s), and/or *methylmethacrylate* are applied to a vertebral defect or interspace during a separately reportable spinal arthrodesis (fusion) procedure. Intervertebral biomechanical devices, also referred to as interbody fusion devices, are placed within the intervertebral disc space to provide strength and prevent collapse of the disc space. There are a number of different types of devices including cylindrical threaded titanium cages, cylindrical threaded cortical bone dowels obtained from cadavers, vertebral interbody rings or boxes, *and methylmethacrylate cement.* During a separately reportable procedure, the disc space is prepared, which includes removing the nucleus pulposus, reaming the disc space with removal of subchondral bone, and/or creating drill holes for placing screws or bone dowels. Distraction is applied to spread the vertebral bodies. The selected intervertebral mechanical device is then inserted into the prepared disc space. If a titanium cage, ring, or box device is used, the device is inserted, fixed with screws, and packed with separately reportable bone grafts (allografts and/or autografts). If threaded bone dowels are used, they are inserted into the predrilled holes in the vertebrae. *If methylmethacrylate is used, the disc space is coated with gelfoam to prevent leakage into the epidural space. The methylmethacrylate cement is then mixed and injected using a syringe and intercath while the vertebral body distracter is removed*


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## jdemar (Jul 30, 2010)

The operative note was a BIG help, I agree with Rebecca's codes as this was an open procedure and not a PERCUTANEOUS VERTEBROPLASTY.


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