Neurology & Pain Management Coding Alert

Report radiologic supervision and interpretation but skip bone biopsies.

When your pain management specialist performs a vertebroplasty or kyphoplasty procedure, you'll need to decide whether you can code and report additional services. Remember these two checkpoints to decide what you can -- and can't -- separately report.

Say 'Yes' to Extra Radiology Pay

CPT includes two sets of codes for vertebroplasty and kyphoplasty:

• 22520-+22522 -- Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection ...
• 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) ...

Good news: You can report the physician's imaging for needle positioning and injection assessment during a kyphoplasty or vertebroplasty procedure. You'll use either 72291 (Radiological supervision and interpretation, percutaneous vertebroplasty, vertebral augmentation, or sacral augmentation [sacroplasty], including cavity creation, per vertebral body or sacrum; under fluoroscopic guidance) or 72292 (... under CT guidance), depending on whether the surgeon uses computed tomography (CT) in addition to fluoroscopic guidance.

CPT revised these codes for 2006 to use with either vertebroplasty or kyphoplasty. Be sure to append modifier 26 (Professional service) to the appropriate radiology service code to show that the specialist provided only the physician component of the service and did not supply the equipment or other services.

Caveat: If your pain management specialist does not personally perform the guidance, you cannot bill for it. Instead, the healthcare professional providing the service (often the facility radiologist) will bill for it.

Steer Clear of Bone Biopsy Code -- Sometimes

Physicians sometimes perform bone biopsy during a vertebroplasty or kyphoplasty procedure. If the biopsy occurs at any of the same spinal levels as the primary procedure, do not include 20225 (Biopsy, bone, trocar or needle; deep [e.g., vertebral body, femur) on your claim.

Here's why: The CPT code descriptors stipulate this limitation, as do many payer local coverage determinations (LCDs). In addition, Correct Coding Initiative (CCI) edits bundle bone biopsy to vertebroplasty and kyphoplasty codes.

"Because there is boney tissue removed during the process anyway, it would not be appropriate to charge for taking some out specifically for a biopsy," says Rena Hall, CPC, billing/insurance specialist of the Kansas City Neurosurgery Group in Missouri.

Alternative: If your surgeon performs bone biopsy at a level not addressed by the vertebroplasty or kyphoplasty, however, you may report the biopsy separately with modifier 59 (Distinct procedural service) to indicate the unrelated nature and separate locations of the two procedures. Several payers further direct you to "identify the site (such as L1) [of the biopsy] in item 19 of the CMS-1500 form or its electronic equivalent."

Example: The surgeon performs kyphoplasty at L2 and L3, with bone biopsy in a separate area, such as L5. In this case, you may report 22524 and +22525 (for the kyphoplasty) plus 20225-59 for the deep bone biopsy at a different location. Had the biopsy occurred at L2 and/or L3, however, it would be bundled to the kyphoplasty, and you could not report it separately.

Plus: Remember that the primary procedure codes for kyphoplasty and vertebroplasty include the mechanical device ("cage"). Therefore, you cannot separately report the cage.