Neurosurgery Coding Alert

Question: During a percutaneous vertebroplasty, the surgeon treats one thoracic level and two lumbar levels. May I claim one -initial level- thoracic code (22520) and one -initial level- lumbar code (22521) in addition to the add-on code 22522 for the final level?


Arizona Subscriber


Answer: If the neurosurgeon performs vertebroplasty in both the thoracic and lumbar regions of the spine during the same operative session, you can still choose only a single -primary- code. You should choose the thoracic code (22520, Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic) for the initial level because it reimburses at a slightly higher rate than the lumbar code (22521, - lumbar).

You will then report add-on code +22522 (- each additional thoracic or lumbar vertebral body [list separately in addition to code for primary procedure]) for each additional level, in either the thoracic or lumbar region, that the surgeon treats.

If, for instance, the surgeon performs vertebroplasty at T12, L1 and L2 (as could be in your case), you would report 22520 for the initial level, and 22522 x 2 for each of the additional lumbar levels.

Remember: All codes 22520-22522 apply to either unilateral or bilateral injections.