Neurosurgery Coding Alert

Question: I have a confusing claim in front of me. The neurosurgeon's notes indicate that she performed a -balloon-assisted percutaneous vertebroplasty.- I have been over and over the vertebroplasty codes, but I cannot find the proper one. Can you help?

Indiana Subscriber

Answer: You are having trouble finding a vertebroplasty code because, despite the term, a -balloon-assisted percutaneous vertebroplasty- is actually a kyphoplasty.

Explanation: When the surgeon performs a kyphoplasty or a vertebroplasty, the surgeon repairs spinal breaks with injections of cement into the vertebral bone. During a kyphoplasty, the surgeon will insert a balloon into the vertebral space to increase the patient's vertebral height
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Some surgeons call kyphoplasties -balloon-assisted percutaneous vertebroplasties,- which is what your surgeon did on the op report.

Remember this: A kyphoplasty restores vertebral height and reduces any spinal deformities; a vertebroplasty strengthens existing bone and prevents any additional spinal deterioration.

Kyphoplasties are represented by the following codes in CPT 2007; you-ll choose the proper code based on what type of kyphoplasty the surgeon performs:

- If the surgeon performed a thoracic kyphoplasty, 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 procedure.

- If the surgeon performed a lumbar kyphoplasty, report 22524 (... lumbar) for the procedure.

- For each additional level the surgeon treats beyond the first (thoracic or lumbar), report +22525 (... each additional thoracic or lumbar vertebral body [list separately in addition to code for primary procedure]).
 
So if the physician performs lumbar kyphoplasty on three vertebral levels, you-d report 22524 and 22525 x 2 on the claim.

Remember: Since 22525 is an add-on code, you should never report it without either 22523 or 22524.