Neurology & Pain Management Coding Alert

Question:  How do we report vertebroplasty at level T10 to L2? Do we report level L1 as another primary level or do we report it as an additional level?

Ohio Subscriber

Answer:  Start with 22520 (Percutaneous vertebroplasty [bone biopsy included when performed], 1 vertebral body, unilateral or bilateral injection; thoracic) for the primary thoracic level T10. You also report +22522 (Percutaneous vertebroplasty [bone biopsy included when performed], 1 vertebral body, unilateral or bilateral injection; each additional thoracic or lumbar vertebral body [List separately in addition to code for primary procedure]) x 4 for the two additional thoracic levels T11 and T12 and the two additional lumbar levels L1 and L2.

Tip: When your physician completes a vertebroplasty at more than one spinal level in a single operative session, you report each additional level by using add-on codes. You report every additional thoracic or lumbar vertebral body with code +22522 with either 22520 or 22521 (Percutaneous vertebroplasty [bone biopsy included when performed], 1 vertebral body, unilateral or bilateral injection; lumbar). Medicare guidelines allow you to report only one primary level code (either 22520 or 22521). Any additional levels addressed are reported with add-on code +22522 regardless of whether the additional level(s) are located in a different region of the spine.

Caution: Don’t append modifier 50 (Bilateral procedure) when your physician does the procedure on same vertebral body on both sides. Vertebroplasty can only be reported per level, and isn’t billed bilaterally. Also note that the “bull’s eye” symbol beside the codes means that moderate sedation is included in the service. 

Radiological assistance: The physician often positions the needle under radiological assistance. If so, include 72291 (Radiological supervision and interpretation, percutaneous vertebroplasty or vertebral augmentation, or sacral augmentation [sacroplasty], including cavity creation, per vertebral body or sacrum; under fluoroscopic guidance) to the claim if the positioning is done under fluoroscopic guidance or 72292 (... under CT guidance) if it is done under computed tomography (CT) assistance. You report 72291 for each level of vertebroplasty.