Orthopedic Coding Alert

Here's how to report the 3 new kyphoplasty CPT Codes

With the addition of three new kyphoplasty CPT codes in 2006, you should make sure you-re differentiating between percutaneous vertebroplasty and kyphoplasty. If you-re coding them the same way, you could be losing reimbursement you deserve and you could open yourself up to denials.

Kyphoplasty (22523-22525) is similar to vertebroplasty (22520-22522), but the two are not identical, and you should not code them in the same way, says Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University department of surgery in New York.

Note: For information on the differences between the two procedures, see our guest column, -Know the Differences Between Vertebroplasty and Kyphoplasty, and the Correct Codes Will Follow- on the front page of this -Extra- supplement issue. Choose Primary Vertebroplasty Code by Location When your surgeon performs percutaneous vertebroplasty, select a single code to describe the -primary level- that the surgeon addressed. Code choices include 22520 (Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic) for levels T1-T12, or 22521 (... lumbar) for levels L1-L5.

During the vertebroplasty, the surgeon injects methylmethacrylate (a cement-like substance) into one or more weakened vertebral bodies. When the substance hardens, it reinforces the bone and helps to relieve pain. Use Add-on Code for Multiple-Level Vertebroplasty If the surgeon performs vertebroplasty at more than one spinal level during the same operative session, report each additional level using add-on code +22522 (... each additional thoracic or lumbar vertebral body [list separately in addition to code for primary procedure]).

Code the primary level and then use this add-on code for the subsequent levels. For example, if the surgeon injects methylmethacrylate into vertebral bodies L2, L3 and L4, you should report 22521 (for the first lumbar level) and 22522 x 2 (to represent the additional levels L3 and L4).

Note: You need not apply modifier 51 (Multiple procedures) to code 22522 because it is a designated add-on code and is not subject to a   multiple-procedure fee reduction. Choose Only 1 Primary Code per Surgery On occasion, the surgeon will treat vertebrae in both the thoracic and lumbar areas during the same operative session. In such cases, you must still choose only a single -primary- code (either 22520 or 22521) and use 22522 for each level beyond the first, even though the surgeon crosses spinal areas.

The primary code describes the injection, the physician's approach and closure, and the surgery's global fee. The add-on code covers only the additional-level injection.

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