Neurosurgery Coding Alert

Question: Our neurosurgeon recently performed a thoracic kyphoplasty on a patient with a closed fracture of one body in the vertebral column. During the encounter, the surgeon also performed open reduction of the fracture. Can I report both procedures?

Missouri Subscriber

Answer: In your scenario, you can only file a code for the kyphoplasty. On the claim, you should:

- 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 the kyphoplasty.

- attach 805.x (Fracture of vertebral column without mention of spinal cord injury) to 22523 to represent the patient's vertebral fracture. Explanation: The National Correct Coding Initiative bundles vertebral fracture reduction (22327, Open treatment and/or reduction of vertebral fracture[s] and/or dislocation[s], posterior approach, one fractured vertebra or dislocated segment; thoracic) with 22523.

Remember: Code 22523 represents kyphoplasty on a single vertebral body. For each additional body the neurosurgeon treats during an encounter, report +22525 (... each additional thoracic or lumbar vertebral body [list separately in addition to code for primary procedure]).