Report radiologic supervision and interpretation, but skip bone biopsies. When your neurosurgeon performs a vertebroplasty or kyphoplasty procedure, you'll need to decide if there are additional services you should be coding and reporting. Get the scoop on what you can -- and can't -- separately report. Modifier 26 Gets You Radiology Pay You can report the operating surgeon'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. You should be sure to append modifier 26 (Professional service) to the appropriate radiology service code to show that the surgeon provided only the physician component of the service and did not supply the equipment, etc. Caveat: Include Bone Biopsy With Main Procedure When you're reporting 22520-+22522 (Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection ...) or 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) ...), you won't code separately for a bone biopsy. You should not report 20225 (Biopsy, bone, trocar or needle; deep [e.g., vertebral body, femur) if the biopsy occurs at any of the same spinal levels as the primary procedure. Here's why: "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: Plus: