Anesthesia Coding Alert

Additions and revisions help ensure you code these procedures more accurately

CPT 2006 brings good news for pain management coders: You won't have to report unlisted codes for kyphoplasty anymore because you-ll have three new, more specific options.

Specific codes for kyphoplasty allow you to report either lumbar or thoracic procedures, plus -each additional- levels:

- 22523--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); thoracic

- 22524--- lumbar

- 22525--- each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure). Physicians use kyphoplasty to repair vertebral compression fractures caused by osteoporosis, cancer or benign lesions. Diagnoses associated with kyphoplasty can include kyphosis (737.10), chronic back pain (724.x), decreased lung function (794.2), impaired physical activities (V49.1) and sleep disorders (780.5x). 

Example: Your physician performs kyphoplasty on L4-L5 to relieve a patient's chronic back pain. Report the procedure with codes 22524 and 22525 along with diagnosis 724.x.

In the past, some coders fell into the trap of mistakenly reporting vertebroplasty codes (22520-22522) for kyphoplasty. Until the new kyphoplasty codes go in effect, you should submit unlisted codes instead, says Trish Bukauskas-Vollmer, CMM, CPC, owner of TB Consulting in Myrtle Beach, S.C.

In addition, new and revised chemodenervation codes show physicians are choosing this method of neurolytic destruction more often. Watch for 64613's updated descriptor (Chemodenervation of muscle[s]; neck muscle[s] [e.g., for spasmodic torticollis, spasmodic dysphonia]) and new codes 64650 (Chemodenervation of eccrine glands, both axillae) and 64653 (-other area[s] [e.g., scalp, face neck], per day).

Bukauskas-Vollmer isn't sure how often pain management coders will rely on these new chemodenervation options. You might use them when the physician administers Botox injections to treat muscle spasms (728.85, Spasm of muscle) or torticollis (723.5, Torti-collis, unspecified, or 333.83, Spasmodic torticollis).