Neurosurgery Coding Alert

Question: Which code(s) are used for kyphoplasty?

Michigan Subscriber

 
Answer: Kyphoplasty is a minimally invasive procedure for treatment of compression fractures of the spine (usually due to osteoporosis). The proper name for this technique is balloon-assisted percutaneous vertebroplasty. To perform the procedure, the surgeon makes an incision on either side of the affected area. A special balloon is inserted into the fractured vertebra(e) and inflated to create a cavity within the bone. The cavity is filled with a special cement to strengthen the bone. Although similar to percutaneous vertebroplasty, this relatively new technique has not yet been assigned a specific CPT code.
 
Kyphon Inc., the company that developed the KyphX system used to perform a kyphoplasty, has recommended 22899 (unlisted procedure, spine) and 76012 (radiological supervision and interpretation, percutaneous vertebroplasty, per vertebral body; under fluoroscopic guidance) with modifier -26 (professional component), or 76013 ( under CT guidance), as appropriate. Individual payers may advise differently, but many Medicare carriers, including Georgia Medicare, Nationwide Medicare, National Heritage Insurance Company (NHIC) and others reimburse for kyphoplasty with these codes.
 
As when billing any procedure with an unlisted procedure code, a full operative report should accompany the claim. Other billing guidelines may also apply. For instance, NHIC local medical review policy # 01-3.2, covering California, specifies:

  Payment for 22899 will be only for the surgical intervention without any follow-up days. Bill all associated services (i.e., the injection, CT, fluoroscopy, intraosseous venography, etc.) and all follow-up E/M services separately.

  Bill only one 22899 per vertebral body treated regardless of the number of balloon tamps placed into a single vertebra.

  If more than one level is treated, multiple-surgery billing guidelines apply.

  Specify kyphoplasty and the number(s) of each vertebral body treated (e.g., T-12, L1) in the comment field of electronic claims, or in block 19 of the HCFA 1500 claim form.

  Use the ICD-9 code to its highest level of specificity.

  When an advance beneficiary notice (ABN) is given to the beneficiary, add modifier -GA (waiver of liability statement on file) to the CPT code.

 
Empire Medicare and other carriers treat kyphoplasty the same as vertebroplasty (22520-22522, depending on location), recommending that the same code be used. Other payers, including Wisconsin Physician Service, have no policy posted, so it is recommended that you inform the patient that he or she may be responsible for payment and ask the patient to sign an ABN. In the event that the procedure is considered investigational, the surgeon can still collect payment from the patient.
 
Because of these varying guidelines, and until kyphoplasty has a CPT code, practices are advised to contact individual payers for their specific requirements.