Neurosurgery Coding Alert

Crossing spinal regions calls for a single -primary- code

If you can't tell percutaneous vertebroplasty (vertebroplasty) from percutaneous vertebral augmentation (kyphoplasty), your coding will suffer. The solution? Focus on documentation details rather than easily confused and often misleading terminology. Step 1: Know the Difference When deciding between kyphoplasty (22523-22525) and vertebroplasty (22520-22522) codes, look for evidence that the neurosurgeon inserted an inflatable bone tamp into the vertebral space.

During both kyphoplasty and vertebroplasty, the neurosurgeon injects bone cement (methylmethacrylate) into a fractured vertebral body to fill the fracture and restore spinal stability. Both are percutaneous procedures that often require only local anesthesia, and both procedures strengthen existing bone to prevent further vertebral collapse.

Only kyphoplasty, however, includes using a balloon to augment vertebral height prior to the injection, says Jennifer Schmutz, CPC, with Neurosurgical Associates LLC in Salt Lake City. As such, some neurosurgeons may refer to kyphoplasty, or vertebral augmentation, as -balloon-assisted percutaneous vertebroplasty.-

Tip: You can often identify kyphoplasty by searching the op note for the words -balloon,- -bone tamp,- -KyphX- (a common brand name for the bone tamp) or -IBT- (for -inflatable bone tamp-). Step 2: Choose Primary Code by Location When reporting either vertebroplasty or kyphoplasty, you must select a code to describe the -primary level- where the neurosurgeon performs the procedure, Schmutz says. CPT divides the procedures into thoracic and lumbar.

For example, you should report 22520 as the -primary level- code for vertebroplasty at levels T1-T12 or 22521 for levels L1-L5.

You would only ever report a single unit of 22520, a single unit of 22521, a single unit of 22523 or a single unit of 22524 per operative session. Step 3: Use Add-on Code for Multiple-Level Procedures If the neurosurgeon treats more than one spinal level during the same operative session, report each additional level using add-on codes +22522 (for vertebroplasty) or +22525 (for kyphoplasty), as appropriate, in addition to the -primary level- code (22520-22521 for vertebroplasty or 22523-22524 for kyphoplasty), says Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University department of surgery.

Example: The neurosurgeon injects methylmethacrylate into vertebral bodies L2, L3 and L4, with balloon assist. In this case, you should report 22524 (for the first lumbar level) and 22525 x 2 (for additional levels L3 and L4).

Note: You need not apply modifier 51 (Multiple procedures) to 22522 or 22525 because they are designated add-on codes and are not subject to a multiple-procedure fee reduction. Step 4: Look for -Cross Region- Surgeries If the neurosurgeon treats vertebrae in both the thoracic and lumbar areas during the same operative session, you will choose only a single -primary- code, says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical [...]