How to Bill for Kyphoplasty, Vertebroplasty and Annuloplasty | What is the CPT code for Kyphoplasty and CPT Code for Vertebroplasty

How to Bill for Kyphoplasty, Vertebroplasty and Aninuloplasty | What is the CPT code for Kyphoplasty and CPT Code for Vertebroplasty

Use CPT Codes 22510, 22511, 22512, 22513, 22514, 22515, 22526, 22527

  • 22510 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic
  • 22511 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; lumbosacral
  • 22512 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; each additional cervicothoracic or lumbosacral vertebral body (List separately in addition to code for primary procedure) *** (Use 22512 in conjunction with 22510, 22511) *** (Do not report 22510, 22511, 22512 in conjunction with 20225, 22310, 22325, 22327 when performed at the same level as 22510, 22511, 22512) 
  • 22513 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic
  • 22514 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; lumbar
  • 22515 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure) *** (Use 22515 in conjunction with 22513, 22514) *** (Do not report 22513, 22514, 22515 in conjunction with 20225, 22310, 22315, 22325, 22327 when performed at the same level as 22513, 22514,22515)
  • 22526 Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level
  • 22527 Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; 1 or more additional levels (List separately in addition to code for primary procedure)

Coding Tips | How to Bill for Kyphoplasty and Vertebroplasty

You must remember that:

How to Bill for Kyphoplasty, Vertebroplasty and Aninuloplasty | What is the CPT code for Kyphoplasty and CPT Code for Vertebroplasty
  1. These codes are billed and coded unilateral or bilateral. Modifier 50 (Bilateral), Modifier LT, RT (Left and Right) will apply.
  2. Modifier 51 does not apply to your “add-on” codes +22512, +22515
  3. All these 6 codes are no longer inclusive with “moderate sedation” since 2017
  4. Code 22510 with “cervicothoracic” means you can now bill the cervical region rather than choosing the unlisted code in 2014 Code 22899 – “unlisted procedure, spine”.
  5. Since the new codes are “inclusive of all imaging guidance” – in 2015, you can no longer bill the radiological codes for guidance

According to the Guidelines of the American Medical Association (who owns CPT): “Codes 22510, 22511, 22512, 22513, 22514, 22515 describe procedures for percutaneous vertebral augmentation that include vertebroplasty of the cervical, thoracic, lumbar, and sacral spine and vertebral augmentation of the thoracic and lumbar spine.”

“For the purposes of reporting 22510, 22511, 22512, 22513, 22514, 22515, “vertebroplasty” is the process of injecting a material (cement) into the vertebral body to reinforce the structure of the body using image guidance. “Vertebral augmentation” is the process of cavity creation followed by the injection of the material (cement) under image guidance. For 0200T and 0201T, “sacral augmentation (sacroplasty)” refers to the creation of a cavity within a sacral vertebral body followed by injection of a material to fill that cavity.”

“The procedure codes are inclusive of bone biopsy, when performed, and imaging guidance necessary to perform the procedure. Use one primary procedure code and an add-on code for additional levels. When treating the sacrum, sacral procedures are reported only once per encounter.”

Moderate Sedation 2017 Billing Changes
How to Bill for Kyphoplasty, Vertebroplasty and Aninuloplasty | What is the CPT code for Kyphoplasty and CPT Code for Vertebroplasty

Separate the Moderate Conscious Sedation Code when billing and reporting claims

Prior to the 2017 change, reimbursement for moderate (conscious) sedation was built into the compensation for the procedure as the anesthesia was administered by the same physician or other qualified health care professional who performed the procedure. This code included conscious sedation as an inherent part of providing the service and was not separately reportable. It has been recognized that practice patterns for some procedures have changed, with anesthesia increasingly reported separately by a provider separate from the one who performs the procedure.

Now, to report moderate (conscious) sedation when provided by the same physician or other qualified health care professional who performs the procedure, see new CPT 2017 codes 99151, 99152, or 99153.

To report moderate (conscious) sedation services provided by a physician or other qualified health care professional other than the provider performing the procedure, see new CPT 2017 codes 99155, 99156, or 99157.

For 2017, existing CPT codes for moderate sedation, 99143-99150, have been deleted.

Reference: 2017, 2018 and 2019 CPT Coding Changes. CPT is a trademark and owned by the American Medical Association

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