Radiology Coding Alert

You'll have to check the guidelines if you want to learn the exception.

A 2012 wording change brings the code definitions for percutaneous vertebroplasty in line with Correct Coding Initiative (CCI) edits. Here's what you need to know.

Vertebroplasty, Kyphoplasty, and CCI All Agree

CPT® 2012, effective Jan. 1, 2012, updates the definitions of 22520-+22522 to clarify that you should not code same-level bone biopsies performed at the same session. Compare the definitions below:

• 2011: Percutaneous vertebroplasty, 1 vertebral body, unilateral or bilateral injection ...
• 2012: Percutaneous vertebroplasty [bone biopsy included when performed], 1 vertebral body, unilateral or bilateral injection ...

The updated wording makes the vertebroplasty codes more consistent with the wording for the kyphoplasty codes, which also specifically include bone biopsy when performed: 22523-+22525 (Percutaneous vertebral augmentation, including cavity creation [fracture reduction and bone biopsy included when performed] using mechanical device, 1 vertebral body, unilateral or bilateral cannulation [e.g., kyphoplasty] ...).

The update is also in accord with CCI edits, which bundle 20225 (Biopsy, bone, trocar, or needle; deep [e.g., vertebral body, femur]) into 22520 (... thoracic) and 22521 (... lumbar).

Tip: Don't be surprised that 20225 isn't bundled into +22522 (...each additional thoracic or lumbar vertebral body [list separately in addition to code for primary procedure]). Because +22522 is an add-on code, you may never report +22522 alone. You always will report it in addition to either 22520 or 22521, and 20225 is bundled into those codes.

Watch for: Just in case you still have the urge to report a bone biopsy code with vertebroplasty, a new note following 22520-+22522 highlights the bone biopsy bundle by instructing you not to report those vertebroplasty codes with bone biopsy code 20225. There is one exception, however, as described below.

Uncover the Bone Biopsy Exception

The combination of code descriptor changes, CCI edits, and CPT® guidelines makes it clear that you should not report bone biopsy with percutaneous vertebroplasty. But that's not the end of the story.

CPT® guidelines state that you should bundle the bone biopsy only "when performed at the same level." That means if the physician performs bone biopsy at a level not addressed by the vertebroplasty, you may report the biopsy separately.

How: Append modifier 59 (Distinct procedural service) to the bone biopsy code to indicate the physician performed the bone biopsy at a different site.

Example: The interventional radiologist performs percutaneous vertebroplasty at L2 and L3, with bone biopsy by needle in a separate area, L5. In this case, you should report 22521 (one lumbar body) and +22522 (additional lumbar body) for the vertebroplasty. You also should report 20225-59 for the bone biopsy at a different location, L5.

Had the biopsy occurred at L2 and/or L3, however, you would not report the biopsy separately because CPT® and CCI include the biopsy in the vertebroplasty code.

Check payer policy: Your payer may further direct you to identify the biopsy site (such as L5) in item 19 of the CMS-1500 form or its electronic equivalent.

Capture Guidance Using 2 Specific Codes

To complete coding the vertebroplasty service, don't forget to report the guidance the radiologist uses. CPT® offers two codes that apply specifically to vertebroplasty:

• 72291, Radiological supervision and interpretation, percutaneous vertebroplasty, vertebral augmentation, or sacral augmentation (sacroplasty), including cavity creation, per vertebral body or sacrum; under fluoroscopic guidance
• 72292, ... under CT guidance.

You should report 72291 if the needle positioning is done under fluoroscopic guidance. Code 72292 is appropriate when the radiologist uses computed tomography (CT) assistance in addition to fluoroscopic guidance. Pay attention to the phrase "per vertebral body or sacrum" in the code definitions. That means you should report one unit for each level where vertebroplasty (or kyphoplasty) is performed, says Heidi Stout, BA, CPC, COSC, PCS, CCS-P, with Coder on Call, Inc., in Milltown, N.J., and The Coding Network, LLC, based in Beverly Hills, Calif.

Final tip: CPT® offers one final tip for your vertebroplasty coding collection. A note following 22520-+22522 instructs you not to report those codes with the following when performed at the same level:

• Closed vertebral fracture treatment codes 22310 and 22315
• Open vertebral fracture treatment codes 22325 and 22327.

CPT® 2012 in focus: Radiology Coding Alert will be featuring how-to, practical advice on more of the 2012 coding changes in the next several issues.