Radiology Coding Alert

Payers will decide your reimbursement for 22523-22525 in 2006

The wait is over. Starting in January, you’ll finally have three codes for reporting kyphoplasty.

Until now, you’ve had to use an unlisted-procedure  code for this fluoroscopically guided procedure, in which the physician uses a balloon tamp to create a cavity that he can fill with cement to restore vertebral height. But 2006 brings you these codes:

• 22523--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); thoracic

• CPT 22524 --... lumbar

• +22525--...each additional thoracic or lumbar vertebral body.

For radiologic supervision and interpretation of these procedures, report 76012 (Radiological supervision and interpretation, percutaneous vertebroplasty or vertebral augmentation including cavity creation, per vertebral body; under fluoroscopic guidance) or 76013 (… under CT guidance). CPT Codes revised these codes for 2006 to use with either vertebroplasty or kyphoplasty.

Warning: The addition of new codes 22523-22525 doesn’t mean you’ll get paid for kyphoplasty, says Jeff Fulkerson, BA, CPC, a certified coder for the department of Radiology at The Emory Clinic in Atlanta. Some payers still view kyphoplasty as an experimental, noncovered procedure. Good news: The presence of these codes may bolster your argument for reimbursement. Prepare presentations and informational packets for payers that deny coverage and meet with them in person to help them update their policies.

You should also check your payer’s policy to determine which diagnosis codes support medical necessity for these procedures.