Orthopedic Coding Alert

Question: Our surgeon performed vertebroplasty at multiple levels. How should we determine which code to report as the primary procedure?


Connecticut Subscriber

Answer: When your surgeon performs percutaneous vertebroplasty, you should select a single code to describe the primary level that the surgeon targeted. If you are choosing between 22520 (Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic) for levels T1-T12 and 22521 (... lumbar) for levels L1-L5, most coders will list 22520 first. That's because 22520 offers 72.45 relative value units, but 22521 pays only 66.06 RVUs.

If the surgeon performs the vertebroplasty procedure at more than one spinal level during the same operative session, you should 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]), even if the additional level is in a different region.

Report the primary level using 22520 or 22521, and then use the 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 (for the additional levels L3 and L4).

Note: You do not need to append modifier 51 (Multiple procedures) to 22522 because it is a designated add-on code and is not subject to a multiple-procedure fee reduction.