This common diagnosis supporting vertebroplasty will become more inclusive.
When your pain management specialist performs vertebroplasty, you have three possible CPT® procedure codes to consider, based on the spinal area and number of vertebral bodies treated:
You also have a range of associated diagnoses that payers might accept for vertebroplasty. One of the most common is 733.13 (Pathological fracture of vertebrae), which will expand into multiple options based on the type of encounter and how the fracture is healing once ICD-10 becomes effective.
ICD-10 Diagnosis Starts With Underlying Reason
The new diagnosis choices for pathological fracture of vertebrae are found in the “M” category of ICD-10 that represents “Diseases of the musculoskeletal system and connective tissue” (Chapter XIII). A closer look shows that they fall into two separate code families:
Coding tip 1: Your providers will need to ascertain and document the underlying cause of the patient’s vertebral fracture and need for vertebroplasty. That knowledge will point you to the correct category of M80 or M84.
Note: The M48 (Other spondylopathies) codes of ICD-10 deal with collapsed vertebrae rather than pathological fractures. Some of these codes such as M48.5xxX could potentially support medical necessity for vertebroplasty, but coverage typically is for pathologic fractures.
Obtain Encounter Status Details
Once you turn to the correct “M” coding family, you’ll have several options to eliminate before reaching the most accurate diagnosis. The seventh digit for the M80 and M84 codes include the following options:
Coding tip 2: Stress the importance of documenting whether the vertebroplasty your pain management specialist performs is initial or subsequent treatment. Notes regarding the fracture status will also help you correctly identify the code’s seventh digit and thus help you choose the most accurate diagnosis.