Percutaneous Vertebroplasty and Kyphoplasty coding tips

Percutaneous Vertebroplasty and Kyphoplasty coding
English: Vertebral column (Photo credit: Wikipedia)
Difference Between Vertebroplasty and kyphoplasty.

Definition: Percutaneous vertebroplasty and kyphoplasty are minimally invasive procedures performed under fluoroscopic or computed tomographic (CT) guidance to relieve pain primarily in patients with vertebral body compression fractures due to osteoporosis. During the procedure, orthopedic cement called polymethylmethacrylate (PMMA), antibiotics and barium or tantalum are injected into the fractured bone. The cement hardens immediately,reinforcing the collapsed vertebrae and providing immediate relief of the patient’s pain.

Kyphoplasty goes one step further and actually restores height to the bone, reducing spinal deformity. Prior to the injection of the cement mixture, a bone tamp or expander is placed in the vertebra and expanded to lift up the fractured vertebra and create a void. The device is removed and then the vertebra is filled with the bone cement to restore the height, realign and stabilized the spine.



Points to check for coding Vertebroplasty and kyphoplasty


History and Physical: The history and physical will indicate intractable back pain due to compression fracture. The age and source of compression fractures must be determined since old or chronic fractures are not usually corrected with these procedures. Ideal candidates for the procedures have recent compression fractures (within 8 weeks) due to osteoporosis. Patients with fever, sepsis, radiculopathy, cord compression or osteomyelitis are not candidates for this procedure.
Diagnostic workup:
Radiology: MRI of the spine
X-Ray of the spine
Bone scan

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Final Note/Summary:
The final note should indicate the procedure(s) performed and the final pathology findings if a bone biopsy was performed. Follow up and treatment options should also be documented.
Indications / Associated Pathology:
recent compression fracture
osteoporosis
metastases
trauma to vertebra
  

Detail description of CPT codes of Vertebroplasty and Kyphoplasty


Procedure Description
CPT code
Percutaneous Vertebroplasty (bone biopsy included) 1 vertebral body, unilateral or bilateral injection: thoracic
22520
Percutaneous Vertebroplasty (bone biopsy included) 1 vertebral body, unilateral or bilateral injection: Lumbar
22521
Percutaneous Vertebroplasty (bone biopsy included) 1 vertebral body, unilateral or bilateral injection: each additional thoracic or lumbar vertebral body
22522
Percutaneous verteral augmentation, including cavity creation (fracture reduction and bone biopsy included) using mechanical device one vertebral body, unilateral or bilateral cannulation (eg. kyphoplasty): Thoracic
22523
Percutaneous verteral augmentation, including cavity creation (fracture reduction and bone biopsy included) using mechanical device one vertebral body, unilateral or bilateral cannulation (eg. kyphoplasty): Lumbar
22524
Percutaneous verteral augmentation, including cavity creation (fracture reduction and bone biopsy included) using mechanical device one vertebral body, unilateral or bilateral cannulation (eg. Kyphoplasty): each additional thoracic or Lumbar vertebral body
22525
Radiological supervision and interpretation percutaneous vertebroplasty, vertebral augmentation or sacral augmentation (sacroplasty), including cavity creation per vertebral body or sacrum: under fluoroscopic guidance
72291
Radiological supervision and interpretation percutaneous vertebroplasty, vertebral augmentation or sacral augmentation (sacroplasty), including cavity creation per vertebral body or sacrum: under CT guidance
72292

The radiological supervision of the vertebroplasty and kyphoplasty procedures, codes 72291 (fluoroscopic guidance) and 72292 (CT guidance), are packaged services and there is no additional reimbursement.


The code assignment of percutaneous vertebroplasty codes 22520-22521 is dependent upon the location of the fracture, thoracic or lumbar, and should only be reported once for the initial vertebral body repaired. If percutaneous vertebroplasty is performed on additional thoracic or lumbar vertebral bodies, add-on code 22522 should also be reported for each additional thoracic or vertebral body repaired. Radiological supervision and interpretation code 72291 or 72292 should also be reported for each vertebral body involved.
Example: A percutaneous vertebroplasty is performed on L1, L2 and L3 during the same operative session using CT guidance. Code 22521 would be assigned once, code 22522 would be assigned twice for the two additional levels and code 72292 would be reported three times for the radiologic guidance at each level.
The code assignment of percutaneous vertebral augmentation or kyphoplasty, (22523-22524) is dependent upon the location of the fracture, thoracic or lumbar, and should only be reported once for the initial vertebral body repaired. If percutaneous vertebral augmentation is performed on additional thoracic or lumbar vertebral bodies, add-on code 22525 should also be reported for each additional thoracic or vertebral body repaired. Radiological supervision and interpretation codes 72291 or 72292 should also be reported for each vertebral body involved.
Careful review of the documentation in the operative report may indicate a bone biopsy performed at the same time as the kyphoplasty or the percutaneous vertebroplasty. The biopsy (20225) is included and should be not be coded in addition to the main procedure of percutaneous vertebroplasty or augmentation (22520-22525). In addition, closed treatment of vertebral fractures with or without manipulation (22310-22315) and open treatment of thoracic or lumbar vertebral fractures (22325, 22327) are inherent components of the kyphoplasty and percutaneous vertebroplasty procedures when performed at the same level and should not be coded.

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