Radiology Coding Alert

Question: If the radiologist performs vertebroplasty that crosses spinal regions (such as from thoracic to lumbar), should I report two separate "primary level" codes for a Medicare patient?

Pennsylvania Subscriber

Answer: No. You should report only one primary code per surgery.

Example: Osteoporosis often occurs at the thoracic-lumbar junction. If the physician 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 (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 the "additional" lumbar level L1.

Reason: CMS has created a Correct Coding Initiative edit (mutually exclusive) for these codes, preventing you from coding two primary codes for the same session. Experts say that physician work is no different whether the physician treats, for instance, T12 and L1 or L1 and L2.

Bottom line: For Medicare patients, report only one primary code even if the physician performs and documents cross-region surgery. Then, report "each additional" codes for all levels beyond the first that the physician treats.