Neurosurgery Coding Alert

Question: What is the difference between percutaneous vertebroplasty (22520-22522) and kyphoplasty? How should I report the latter?

Washington Subscriber

Answer: During both vertebroplasty (22520-22522) and kyphoplasty, the surgeon injects a cement material into the patient's vertebral bone to repair spinal fractures, usually due to osteoporosis (733.00-733.09). With kyphoplasty, however, the surgeon first inserts a balloon into the vertebral space and then inflates it to help restore vertebral height. Due to the additional work involved, most carriers pay about 20 percent more for kyphoplasty than for vertebroplasty.

Kyphoplasty does not have a dedicated CPT code, so the best choice is 22899 (Unlisted procedure, spine). Report one unit of 22899 for each spinal level attended. Most carriers consider 22899 all-inclusive and deny additional claims for fluoroscopy, injections and any other procedures provided during the kyphoplasty.

Although kyphoplasty does not have its own CPT code, many carriers maintain local medical review policies (LMRPs) designating how to bill for it and how they pay for it and the guidelines vary widely. For example, the California Medicare carrier's (NHIC) policy states that kyphoplasty coverage does not include any follow-up days meaning that you should report all postoperative visits separately. Some commercial payers still appear to consider the procedure investigational, and therefore not covered.

TrailBlazer LLC (the Part B carrier for the District of Columbia metropolitan area) requires practices to list a description of the procedure on the CMS-1500 claim form, "or the words 'balloon-assisted percutaneous vertebro-plasty'in the comments section of the electronic claim form." You should also specify the spinal levels the physician treated. On the other hand, some carriers simply request the operative report.

Most carriers cover kyphoplasty for pathologic vertebral fractures (733.13). Nonetheless, some payers, such as Empire Medicare (the Part B carrier for New York), expand coverage for other conditions on a case-by-case basis absent fracture, as long as documentation (such as test reports) indicates that kyphoplasty is appropriate. For example, Empire may cover kyphoplasty for patients with malignant neoplasm of the vertebral column (170.2), hemangioma (228.09), and other conditions.