Orthopedic Coding Alert

Orthopedic Coding Alert, Vol. 10, No. 9, recommended that when reporting kyphoplasty or vertebroplasty that crosses spinal regions (from thoracic to lumbar) you should report two separate -primary-level- codes (-6 Easy Steps Distinguish Kyphoplasty From Vertebroplasty -- and Get Your Claims Paid,- pp. 89-92). This advice -- although based on AMA recommendations published in the CPT Assistant (March 2001) -- no longer applies.

-Despite the CPT Assistant of six years ago, this coding method is incorrect,- says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, N.J. -You should report only one primary code, even if cross-region surgery is performed, and you-ll want to choose the thoracic code [22520 for vertebroplasty or 22523 for kyphoplasty] as primary, given its slightly higher valuation.-

You would then report -each additional- codes -- +22522 (Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; each additional thoracic or lumbar vertebral body [list separately in addition to code for primary procedure]) for vertebroplasty or +22525 (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]; each additional thoracic or lumbar vertebral body [list separately in addition to code for primary procedure]) for kyphoplasty -- for all levels beyond the first that the surgeon treats.

Correct example: Osteoporosis often occurs at the thoracic-lumbar junction. If the orthopedist injects vertebrae T12 and L1 in such a case, you should report 22520 (Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic) for the primary thoracic level T12 and 22522 for the -additional- lumbar level L1.

The rationale: -During the valuation of kyphoplasty, as well as the five-year review process for vertebroplasty, the Society presenters confirmed the correct coding as a single primary code, even when crossing regions,- Przybylski says. -The rationale is that physician work is no different whether one treats, for instance, T12 and L1 or L1 and L2. CMS has created an edit for this, precluding coding two primary codes for the same session.-