Anesthesia Coding Alert

Youll no longer have to use 01999 (unlisted anesthesia procedure[s]) to report percutaneous vertebroplasty, a therapeutic, interventional radiologic procedure used to treat vertebral fractures. CPT 2001s pain code modifications include a series of new specific codes for the procedure:

22520 percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic;
22521 lumbar; and
22522+ each additional thoracic or lumbar vertebral body.

Correctly submitting these new codes, accompanied by substantiating diagnoses for medical necessity and detailed documentation of the procedure, will increase your reimbursement.

Code Smart Details, Diagnosis, Documentation

Details: Because the codes refer to specific areas of the spine, documentation for the procedure must include details, for example, at which level of the spine the anesthesiologist administered the injection lumbar, thoracic or cervical.

Diagnosis: Many states have policies that outline acceptable diagnoses for percutaneous vertebroplasty, therefore its best to check with your local carrier. For example, United Healthcare in Virginia includes the following diagnosis codes as acceptable for supporting medical necessity:

ICD-9 170.2 malignant neoplasm of vertebral column, excluding sacrum and coccyx;
ICD-9 198.5 secondary malignant neoplasm of bone and bone marrow;
203.00 multiple myeloma; without mention of remission;
ICD-9 203.01 multiple myeloma; in remission; and
ICD-9 238.0 neoplasm of uncertain behavior of bone and articular cartilage.

Documentation: To help document medical necessity, Sanjit Chada, an insurance biller for the Surgery Center in Beverly Hills, Calif., says anesthesiologists should make sure the medical record shows that other noninvasive treatments for pain management, such as medications and transcutaneous electrical nerve stimulation (TENS), were tried and failed.

Use New Cross Codes

The American Society of Anesthesiologists (ASA) current issue of Crosswalk already includes cross codes for this relatively new procedure. Anesthesia coding specialist Barbara Johnson, CPC, MPC, member of the National Advisory Board of the American Academy of Professional Coders and an anesthesia coding professional with Loma Linda University Anesthesiology Medical Group in Loma Linda, Calif., says you would use only one cross code for the percutaneous vertebroplasty procedure and vary it according to the site of the injection. For reporting purposes, ASA recommends that with code CPT 22520 you use Crosswalks 00620 (anesthesia for closed procedures on cervical, thoracic, or lumbar spine. Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic). For procedures coded with 22521, ASA recommends using the same cross code number but changing the description to ( ...; lumbar). ASA does cross reference CPTs 22522 because it is not a primary procedure code.