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Neurosurgery Coding Alert

Look for Better Kyphoplasty, Vertebroplasty Coverage

Published on Wed May 18, 2005

Continue to use 22899 for Medicare kyphoplasty claims

Practices billing for percutaneous kyphoplasty must still rely on temporary or unlisted-procedure CPT codes, but choosing a diagnosis is easier now that some payers have approved more ICD-9 codes to justify the procedure.

Turn to S Codes for Private Payers

When choosing a procedure code to describe kyphoplasty, you should turn to HCPCS temporary codes S2362 (Kyphoplasty, one vertebral body, unilateral or bilateral injection) and S2363 (... each additional vertebral body [list separately in addition to code for primary procedure]), or 22899 (Unlisted procedure, spine), depending on the payer, says Heidi Stout, CPC, CCS-P, coding and reimbursement manager at UMDNJ-RWJ University Orthopaedic Group in New Brunswick, N.J.

HCPCS introduced S2362 and S2363 in 2004, but Medicare did not assign any relative value units (RVUs) to the codes. Therefore, you should report these codes only to private payers that recognize them: If you're reporting kyphoplasty to Medicare, you should continue to use the code for unlisted spine procedures (22899).

Here's proof: Cigna Medicare (a Part B carrier in Idaho, North Carolina and Tennessee) recently issued a new medical review "Frequently Asked Questions" file about kyphoplasty for vertebral compression fracture surgery. Like other Medicare carriers, Cigna specifically instructs providers to use unlisted-procedure code 22899 for the procedure.

Check With Payer for Allowable Dx

AdminaStar Federal (a Part B carrier in Indiana) will cover kyphoplasty for two indications:
 

  • a recent osteoporotic compression fracture of the lumbar or thoracic vertebrae with persistent debilitating pain that hasn't responded to treatment; or
     
  • multiple myeloma or osteolytic metastatic disease leading to osteolytic vertebral collapse, according to a recent draft local coverage determination (LCD).

    In contrast, the same LCD states that AdminaStar will cover vertebroplasty (for example, 22520, Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic) for a laundry list of conditions, including osteoporotic or osteolytic vertebral compression fractures; osteolytic metastasis or multiple myeloma, with severe back pain related to destruction of the vertebral body; painful or aggressive hemangiomas; painful vertebral fracture associated with osteonecrosis; or the need to reinforce or stabilize the spine prior to surgery.

    AdminaStar's LCD represents "a great step forward," especially for kyphoplasty, says Jeff Fulkerson, BA, CPC, CMC, senior certified coder in the radiology department of Emory Health Care in Stockbridge, Ga. "Kyphoplasty is moving into the light," he says.

    Keep a Lookout for More Improvements

    You'll want to keep watching your payers' LCDs for shifts in kyphoplasty coverage. For example, some carriers have already finalized LCDs that go further than AdminaStar's draft policy.

    Cahaba GBA (Alabama, Georgia and Mississippi) and First Coast Service Options (Florida) cover more diagnoses for kyphoplasty than AdminaStar will allow, and Wisconsin Physicians Service Insurance Corp. (Wisconsin) issued a single policy for both kyphoplasty and vertebroplasty that covers both procedures for a comprehensive list of diagnoses similar to AdminaStar's vertebroplasty coverage list.

    The ideal: Carriers ought to cover both vertebroplasty and kyphoplasty for the same list of conditions, Fulkerson says. Some patients may be able to tolerate vertebroplasty but not kyphoplasty, which is more invasive, he says. Kyphoplasty involves drilling into the patient's spine and inserting a balloon catheter, then blowing it up. Some patients in a "fragile state" may not be able to handle such an invasive procedure, he adds.

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