# Perc. Vertebroplasty 22520 with 22521 or 22522



## allaire_s (May 24, 2012)

Hi!
I am studying for the CIRCC exam and here ir my question. There are different opinions of how to code percutaneous vertebroplasty performed on 2 levels: lumbar and thoracic.

Here is a quote from AAPC Coding Edge  February 25th, 2011:
_"For example, osteoporosis, a common condition for which physicians use percutaneous vertebroplasty, often occurs at the thoracic/lumbar junction. If the surgeon treats the final thoracic vertebra (T12) and the first lumbar vertebrae (L1), report 22520, 22522."_

And Dr.Z's Interventional Radiology Book gives the same example with the following codes: T12 22520; L1 22521-59

So the difference is that AAPC is using the add-on code for the second vertebrae treated and Dr.Z is not using the add-on code.

Has anybody coded these and what is your opinion??

Thanks, Santa Allaire, CPC, CEMC


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## donnajrichmond (May 24, 2012)

From the beginning, AMA and other societies said that if a thoracic and a lumbar vertebra were treated, then each would be coded with the inital level code. 
For example if T12 and L1 were both treated you would code 22520 and 22521.  
If T12, L1, and L2 were coded you would code 22520, 22521, and 22522. 

Now, however, CMS in the NCCI Policy Manual has changed that and now indicate that only one initial code can be used.  
In the above examples of T12 and L1, according to CMS this would be 22520 and 22522. 
T12, L1 and L2 would be 22520, 22522, 22522. 

It will be interesting to see if AMA, SIR, ACR, etc. change their coding guidance.


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## allaire_s (May 24, 2012)

Thanks for your reply! I was confused with different info and wanted to ask somebody!! Thanks!
Santa


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## Lana1752 (May 25, 2012)

Help!  After the Noridian Vertebroplasty webinar yesterday, we ended up in a discussion about documentation.  Is there any written rules as far as what we can code off of?  EX:  The interventional radiologist does a history and consultation on a patient and sends a report back to the referring doctor.  Are we allowed to just have the rad refer to the history in a report that goes back or does he/she need to add ALL of the social/fam history in the report.  It seems redundant to me as the history and progress notes are all part of the visit.  We are going into a follow up meeting today and I was hoping for help before then....


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## Jim Pawloski (May 25, 2012)

donnajrichmond said:


> From the beginning, AMA and other societies said that if a thoracic and a lumbar vertebra were treated, then each would be coded with the inital level code.
> For example if T12 and L1 were both treated you would code 22520 and 22521.
> If T12, L1, and L2 were coded you would code 22520, 22521, and 22522.
> 
> ...



Hi Donna,

Thanks for the information.  I work with Neuroradiologists in the performance of a vertebroplasty, but I didn't know about the NCCI change, since I don't bill for many of these.

Jim Pawloski, CIRCC


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## dpeoples (May 25, 2012)

donnajrichmond said:


> From the beginning, AMA and other societies said that if a thoracic and a lumbar vertebra were treated, then each would be coded with the inital level code.
> For example if T12 and L1 were both treated you would code 22520 and 22521.
> If T12, L1, and L2 were coded you would code 22520, 22521, and 22522.
> 
> ...



Thanks for the info Donna, it is quite helpful. This was a change that actually made good sense IMO.


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