Neurosurgery Coding Alert

Question: May we report bone biopsy separately with kyphoplasty? We-ve begun to receive rejections for this.

Oklahoma Subscriber

Answer: No, you should not report bone biopsy (20225, Biopsy, bone, trocar or needle; deep [e.g., vertebral body, femur]) if the biopsy occurs at any of the same spinal level(s) as either kyphoplasty (22523-+22525) or vertebroplasty (22520-+22522). The national Correct Coding Initiative (CCI) edits bundle bone biopsy to vertebroplasty and kyphoplasty codes.

If the surgeon performs bone biopsy at a level not addressed by the vertebroplasty or kyphoplasty, however, you may report the biopsy separately with modifier 59 (Distinct procedural service) to indicate the unrelated nature of the two procedures. Several payers further direct you to "identify the site (such as L1) [of the biopsy] in item 19 of the CMS-1500 form or its electronic equivalent."

Example: The surgeon performs kyphoplasty at L2 and L3, with bone biopsy in a separate area, such as L5. In this case, you may report 22524 and 22525 (for the kyphoplasty) plus 20225-59 for bone biopsy at a different location.

Had the biopsy occurred at L2 and/or L3, however, it would be bundled to the kyphoplasty, and you could not report it separately.