Neurosurgery Coding Alert

Tip: The word "balloon" will direct you to this procedure every time.

Did you conquer the coding challenge on page 3? Read on to find out.

Answer 1: False.

The procedure described in this question is a kyphoplasty procedure, although some physicians refer to kyphoplasty as "balloon-assisted percutaneous vertebroplasty." During both kyphoplasty and vertebroplasty, the neurosurgeon injects a cement material into the patient's vertebral bone to repair spinal fractures.
Both procedures are typically performed percutaneously, and often under only local anesthesia. During vertebroplasty, the surgeon introduces cement into the fractured vertebral body to fill any spaces and increase stability. Positioning of the patient for vertebroplasty may result in postural reduction of the fracture. "Only kyphoplasty restores vertebral height," says Sharlene A. Scott, CPC, CPC-H, CCS-P, CCP-P, PMMC, the presenter of "Kyphoplasty Vs. Vertebroplasty: Smooth Out the Coding Bumps and Get Paid!" at The Coding Institute's 2008 Multispecialty Conference. (Go to www.codingconferences.com to order a CD).

Tip: "Look for wording suggesting the physician inserted an inflatable balloon into the vertebral space, because a kyphoplasty requires the insertion of a balloon to augment vertebral height," Scott says.

CPT created three kyphoplasty procedure codes in 2006. For lumbar kyphoplasty on a single level, you should report one unit of 22524 (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]; lumbar).
If the neurosurgeon performs a thoracic kyphoplasty, however, you should instead report 22523 (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]; thoracic).
For kyphoplasty procedures at each additional level, you-ll report +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]; each additional thoracic or lumbar vertebral body [List separately in addition to code for primary procedure]), says Margaret Mize, CPC, coder and billing clerk for Birmingham Neurosurgery & Spine Group, PC in Alabama.

When your surgeon performs percutaneous vertebroplasty, you should select a single code to describe the primary level that the surgeon targeted. You-ll choose between 22520 (Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic) for levels T1-T12, and 22521 ( ... lumbar) for levels L1-L5.
If the neurosurgeon performs the vertebroplasty procedure at more than one spinal level during the same operative session, you should report each additional level using add-on code +22522 ( ... each additional thoracic or lumbar vertebral body [List separately in addition to code for primary procedure]), even if the additional level is in a different region.
Report the primary level using 22520 or 22521, and then use this add-on code for the subsequent levels. For example, if the surgeon injects methylmethacrylate into vertebral bodies L2, L3, and L4, you should report 22521 (for the first lumbar level) and 22522 x 2 (to represent the additional levels L3 and L4).

Answer 4: True. When using fluoroscopic guidance for kyphoplasty or vertebroplasty, report 72291. For CT guidance with either procedure, report 72292. Although the Correct Coding Initiative (CCI) bundles the kyphoplasty codes (22523-22524) with several other codes for spine computed tomography and fluoroscopy, codes 72291 and 72292 are specific for vertebroplasty and kyphoplasty procedures.