Neurosurgery Coding Alert

Question: One of our neurosurgeons performed a percutaneous vertebroplasty on two vertebral levels for an osteoporosis patient. How should I code this encounter?

Texas Subscriber Answer: It depends on whether the neurosurgeon performs a thoracic or lumbar vertebroplasty during the encounter; there are separate codes for each procedure.

Thoracic: Your neurosurgeon conducts a thoracic vertebroplasty on levels T1 and T2. On the claim,

- report 22520 (Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic) for the initial vertebroplasty.

- report +22522 (... each additional thoracic or lumbar vertebral body [list separately in addition to code for primary procedure]) for the second level.

- attach ICD-9 code 733.00 (Osteoporosis, unspecified) to 22520 and 22522 to represent the patient's osteoporosis. Lumbar: If the neurosurgeon performs the vertebroplasty at levels L3 and L4, you would:

- report 22521 (... lumbar) for the initial procedure.

- report 22522 for the second level.

- attach ICD-9 code 733.00 to 22521 and 22522 to represent the patient's osteoporosis. Remember: You should never report 22520 and 22521 together on the same claim. If the neurosurgeon treats vertebrae in both the thoracic and lumbar regions during the same session, you must choose one of the codes as the primary procedure. Further, since 22522 is an add-on code, you will not need to append modifier 59 (Distinct procedural service) when you report the code.