Do Not Miss Out On Ancillary Procedures with Kyphoplasty, Vertebroplasty

Do Not Miss Out On Ancillary Procedures with Kyphoplasty

, Vertebroplasty

Report radiologic supervision and interpretation, however leave out bone biopsies.

When your orthopedist carries out a vertebroplasty or kyphoplasty procedure, you will need to decide if there are additional services you could be coding and reporting. Get the low down on what you can and cannot report separately.

Modifier 26 brings you radiology pay

You can report the operating surgeon's imaging for needle positioning and injection assessment during a kyphoplasty or vertebroplasty procedure. You will use either 72291 or 72292 in addition to fluoroscopic guidance.

CPT revised these codes for 2006 to use with either vertebroplasty or kyphoplasty. You should be sure to append modifier 26 (PC) to the appropriate radiology service code to show that the surgeon provided only the physician component of the service and didn't supply the equipment, etc.

Caution: If your surgeon doesn't personally carry out the guidance, you can't bill for it. Rather, the healthcare professional who provides the service (often the facility radiologist) will bill for it.

Include bone biopsy with main procedure

When you are reporting 22520-+22522 or 22523-+22525, you won't code separately for a bone biopsy. You shouldn't report 20225 if the biopsy occurs at any of the same spinal levels as the primary procedure.

Here is the reason: The CPT code descriptors stimulate this limitation as do many payer local coverage determinations (LCDs). To add to it, CCI edits bundle bone biopsy to vertebroplasty and kyphoplasty codes. As there's boney tissue removed during the process anyway, it wouldn't be right to charge for taking some specifically for a biopsy.

Alternative: If your surgeon carries out bone biopsy at a level not addressed by the vertebroplasty or kyphoplasty, but you may report the biopsy separated with modifier 59 (distinct procedural service) to indicate the unrelated nature and separate locations of the two procedures.

For more on this, sign up for a medical coding guide like Supercoder!

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