Tips to Help you Capture Percutaneous, Kyphoplasty, Vertebroplasty Payment

If you do not know the difference between kyphoplasty and vertebroplasty, you and practice are in for denials and lost reimbursement. Kyphoplasty is similar to vertebroplasty, however the two are not identical and you should not code them in the same way. Boost your coding for these common neurosurgical procedures by following these five tips:

Distinguish Kyphoplasty and Vertebroplasty Codes

CPT offers three vertebroplasty and three kyphoplasty codes. The spinal level on which the neurosurgeon carries out the procedure determines which code you will go for. The vertebroplasty codes cover thoracic, lumbar, and each additional thoracic or lumbar vertebral body.

Base your primary code on spinal location

When reporting either vertebroplasty or kyphoplasty, you must choose a code to describe the ‘primary level’ where the surgeon carries out the procedure. CPT divides the procedures into thoracic and lumbar as noted in the code descriptors above.

Tackle multi-level procedures with add-on codes

If your surgeon treats more than one spinal level during the same operative session, report each additional level using add-on codes for vertebroplasty or for kyphoplasty. The primary code describes the injection, the physician’s approach and closure and the surgery’s global fee.

Stick with an unlisted code for cervical procedures

You may have noticed that one section of the spine is missing in the CPT code offerings for vertebroplasty and kyphoplasty procedures: the cervical vertebra(e). However your neurosurgeon may carry out these procedures. Most payers recommend that you go for 22899 for cervical vertebroplasty or kyphoplasty, although you should check with your payer prior to billing to be sure about individual guidelines.

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