Anesthesia Coding Alert

Question: My physician performed a bilateral kyphoplasty, and I billed 22523 with modifier 50, but the claim was denied. Isn't it a bilateral procedure?

Tennessee Subscriber

Answer: You would normally append modifier 50 (Bilateral procedure) when a procedure is performed bilaterally. Kyphoplasty (22523-22525, Percutaneous vertebral augmentation, including cavity creation [fracture reduction and bone biopsy included when performed] using mechanical device, one vertebral body, unilateral or bilateral cannulation [e.g., kyphoplasty] . . .), however, happens to be one of those tricky CPT codes that is already bilateral in nature. In fact, that component is built right into the code description.

Therefore, you should not append modifier 50 to kyphoplasty procedures, such as 22523.

The same rule applies to the other kyphoplasty codes:

22524 -- ... lumbar

+22525 -- ... each additional thoracic or lumbar vertebral body (list separately in addition to code for primary procedure).

Also consider: During kyphoplasty, the specialist injects bone cement (methylmethacrylate) into a fractured vertebral body to fill the fracture and restore spinal stability. When reporting this procedure, you must select one of the three codes above to describe the "primary level" where your pain management specialist performed the procedure. CPT divides the procedures into thoracic and lumbar. You can report the add-on code (22525) reported with either of the two "primary level" codes.