Neurosurgery Coding Alert

Are you coding percutaneous vertebroplasty and kyphoplasty the same way? If so, you could be losing as much as 20 percent of the reimbursement you deserve. Fortunately, coding for these procedures accurately is easy, if you follow these guidelines, coding experts say. 1. Choose One Primary Code by Location When reporting percutaneous vertebroplasty, select a single code to describe the "primary level" where the surgeon performs the procedure. Code choices include 22520 (Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic) for levels T1-T12 or 22521 (... lumbar) for levels L1-L5. During the vertebroplasty, the surgeon injects methyl methacrylate (a cement-like substance) into one or more weakened vertebral bodies. When the substance hardens, it reinforces the bone and helps to relieve pain. You should report only 22520 or 22521 during the same session, never both, says Anita Day Foster, MA, CPC, vice president of the Coding Network, a network of coders that provides services to academic environments in Beverly Hills, Calif. 2. Employ the 'Each Additional' Code for Multiple Levels If the surgeon performs vertebroplasty at more than one spinal level during the same operative session, report each additional level using add-on code +22522 (... each additional thoracic or lumbar vertebral body). For example, if the surgeon injects methyl methacrylate into vertebral bodies L2, L3 and L4, you should code 22521 (for the first lumbar level) and 22522 x 2 (for additional levels L3 and L4). Note: You need not apply modifier -51 (Multiple procedures) to 22522 because it is a designated add-on code and is not subject to a multiple-procedure fee reduction. On occasion, the surgeon will treat vertebra in both the thoracic and lumbar areas during the same operative session, says Kee D. Kim, MD, associate professor of neurosurgery at University of California, Davis in Sacramento. In such cases, you must still choose only a single "primary" code (either 22520 or 22521) and use 22522 for each level beyond the first, even though the surgeon crosses spinal areas. The primary code describes not only the injection but also the approach and closure, as well as the global fee for the surgery, Foster says. The add-on code covers only the additional-level injection. If you report two primary codes during the same surgery, you are double-billing for the global fee and other components not included in the add-on code fee. For example, osteoporosis, a common condition treated using percutaneous vertebroplasty, often occurs at the thoracic/lumbar junction. If the physician injects vertebrae T12 and L1 in such a case, you should report 22520 (for the primary thoracic level T12) and 22522 for the additional lumbar level L1. In a second example, the surgeon provides vertebro-plasty at vertebrae T10, T11, T12, [...]