# Aborted Kypho?



## kseeg23 (Jul 7, 2014)

I'm not sure how to code this procedure. Would I report 22523 with a 52 or 53 modifier or would I just end up coding the biopsy as 20250? This seems tricky so any help would be appreciated. Thanks

 The skin overlying the area to be injected was prepped with duraprep. All surgical staff involved with performing the procedure wore standard sterile gown, mask, hat and gloves. Sterile drapes were placed around the operative field. A local anesthetic skin wheal was raised with 2% lidocaine using a 25 gauge needle. Under fluoroscopic guidance, two 10 gauge trocar needles were then advanced bipedicular at the targeted level. Flouroscopy in the AP and lateral views was used multiple times throughout the procedure to verify correct placement of the needles. A mallet was used to try to advance the trocars into the vertebral body. A hand drill was then inserted into the left sided trocar to attempt to drill a space for the balloon. A bone biopsy was obtained. Due to the extreme density of the bone, neither the trocar or the drill was able to reach the middle of vertebral body. Because of this the procedure was aborted. The cannulas were removed and hemostatis achieved. Mastisol and steri-strips were used to close the incision. The patient tolerated the procedure well and there were no clinical complications. The procedure was performed at the following levels T10.  
Radiation exposure time: 1 minute 42 seconds


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## dwaldman (Jul 8, 2014)

20250 is for an open approach bone biopsy.

I believe this was a percutaneous approach. If a bone biopsy was planned to be performed in addition to the vertebral augmentation/kyphoplasty.

I think although discontinued procedures are sometimes difficult to report since it does appear the bone biopsy was completed and it doesn't appear the other planned procedure was too far into the procedure before it was decided to be discontinued then the completed procedure could be reported.

I believe you could report the bone biopsy with fluoroscopy

20225  Biopsy, bone, trocar, or needle; deep (eg, vertebral body, femur) 
77002


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## kseeg23 (Jul 10, 2014)

Here's what the procedure note says...

The patient was taken to the procedure room and placed in the prone position. Standard non-invasive monitors were then applied. Confirmation of the procedure to be performed was obtained from the patient. Vital signs and sedation were monitored and administered by a sedation nurse under supervision of the doctor . The skin overlying the area to be injected was prepped with duraprep. All surgical staff involved with performing the procedure wore standard sterile gown, mask, hat and gloves. Sterile drapes were placed around the operative field. A local anesthetic skin wheal was raised with 2% lidocaine using a 25 gauge needle. Under fluoroscopic guidance, two 10 gauge trocar needles were then advanced bipedicular at the targeted level. Flouroscopy in the AP and lateral views was used multiple times throughout the procedure to verify correct placement of the needles. A mallet was used to try to advance the trocars into the vertebral body. A hand drill was then inserted into the left sided trocar to attempt to drill a space for the balloon. A bone biopsy was obtained. Due to the extreme density of the bone, neither the trocar or the drill was able to reach the middle of vertebral body. Because of this the procedure was aborted. The cannulas were removed and hemostatis achieved. Mastisol and steri-strips were used to close the incision. The patient tolerated the procedure well and there were no clinical complications. The procedure was performed at the following levels T10.  
Radiation exposure time: 1 minute 42 seconds 

so do i just report the biopsy code or the kypho with a modifier showing it was aborted?


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## dwaldman (Jul 10, 2014)

If the bone had density that would threaten the well being of the patient if procedure was proceed I believe modifier 53 would apply.

The bone biopsy can provide diagnostic information if that was initially planned to be performed. So I could see this be reported for your case.

Or you could take the stance that the biopsy is included and that you should bill the aborted kypho procedure code with modifier.

I think modifier 53 versus 52 can be difficult to determine. But I have looked to modifier 52 when certain amount of the procedure was performed but not the total procedure. But when risk to patient's well-being or other circumstances that call for the procedure to be aborted I would use modifier 53 
Regardless, 53 or 52, you have to put on the claim additional information upon request. And they have to manual process in a similar process.


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## kseeg23 (Jul 15, 2014)

Thank you so much!


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