Neurosurgery Coding Alert

Prepare to include kyphoplasty/vertebroplasty guidelines.

It is time to check your practices for vertebroplasty and epidural infusion codes as CMS has published its list of CCI Manual updates. Update your coding with revisions for codes for these procedures. These practices can impact your payment. Here are some latest CCI updates.

Submit Only One Primary Procedure Code

Codes 22510-22512 (Percutaneous vertebroplasty [bone biopsy included when performed], 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance …) represent percutaneous vertebroplasty to different spinal areas. Similarly, codes 22513-22515 (Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device [e.g., kyphoplasty], 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance …) describe kyphoplasty to specific spinal locations. 

When reporting either of these procedures, you should only submit one primary procedure code (such as 22510 or 22513) and the add-on code for the procedure (+22512 or +22515) for each additional level, whether the additional level(s) are contiguous or not. 

“This is consistent with the coding rules for add-on codes for additional levels in other spinal procedures,” says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center, Edison. “The rationale for this policy is a consequence of the total physician work included in the primary code compared with the add-on code. While the primary code contains pre-service work (eg. evaluation of the patient, positioning the patient) and post-service work (eg. post-operative documentation, providing discharge instructions, follow-up visits in the global period), the add-on code typically only includes the additional surgical work after the procedure has started and before the procedure has finished.  This is similar to the effect of the application of the -51 modifier (multiple procedure rule) on two stand-alone codes to reduce the duplicative pre-service and post-service work.”

Example: T12 and L1 percutaneous vertebroplasty would be reported with 22510 and the add-on code, 22512, each with one unit of service. The vertebroplasty should not be billed as 22510 and 22511 as two primary procedure codes.

Do Not Submit A4220 with 62369

Medicare payment for programmable pump analysis, reprogramming, and refill includes the refill kit. 

What does this mean for you? You do not submit HCPCS code A4220 (Refill kit for implantable infusion pump) separately with CPT® codes 62369 (Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion [includes evaluation of reservoir status, alarm status, drug prescription status]; with reprogramming and refill) or 62370 (… with reprogramming and refill [requiring skill of a physician or other qualified health care professional]).

“The relative value units in procedure codes have a practice expense component that includes supplies that are used with the procedure,” Przybylski says. “CPT® 62369 includes the refill kit among the practice expense inputs, but not the medication that would be instilled.”

Learn more: To see the complete manual, log on to: http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html.