Anesthesia Coding Alert

Question: Our providers offer kyphoplasty in the office setting. One physician performs the kyphoplasty and another physician or a CRNA provides anesthesia. Is this billable, and can the physician doing the kyphoplasty also be the supervisor for the CRNA?

Arizona Subscriber

Answer: CPT^® includes three codes for kyphoplasty, based on the spinal site and number of vertebral bodies treated:

• 22513 (Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic)
• 22514 (… lumbar)
• +22515 (Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, 1 vertebral body, unilateral or bilateral cannulation (e.g., kyphoplasty); each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure))

Report these codes as appropriate for the physician performing the kyphoplasty. Report the anesthesia with 01936 (Anesthesia for percutaneous image guided procedures on the spine and spinal cord; therapeutic), whether the provider is an anesthesiologist or CRNA.

The physician cannot perform the procedure and also medically direct or supervise the CRNA at the same time. If a CRNA provides the anesthesia, submit the claim with 01936 and append modifier QZ (CRNA service: without medical direction by a physician). Only report the applicable kyphoplasty code for the physician.