CPT® includes three codes to describe kyphoplasty, which mirror the vertebroplasty codes: Code 22513 describes the initial vertebral body as treated in the thoracic area. Code 22514 describes the initial vertebral body as treated in the lumbar area. Select only one “initial” level (either 22513 or 22514).
Kyphosis. Kyphosis deformity of spine. Kyphosis, acquired. Kyphosis, idiopathic. ICD-10-CM M40.209 is grouped within Diagnostic Related Group (s) (MS-DRG v37.0): 456 Spinal fusion except cervical with spinal curvature or malignancy or infection or extensive fusions with mcc.
Code 22514 describes the initial vertebral body as treated in the lumbar area. Select only one “initial” level (either 22513 or 22514). For each additional vertebral body treated, beyond the first, report one unit of add-on 22515. Additional coding rules mimic those we applied, above, for vertebroplasty:
2018/2019 ICD-10-CM Diagnosis Code Z47.89. Encounter for other orthopedic aftercare. Z47.89 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
080G.
ICD-10 code S22. 060A for Wedge compression fracture of T7-T8 vertebra, initial encounter for closed fracture is a medical classification as listed by WHO under the range - Injury, poisoning and certain other consequences of external causes .
Other specified postprocedural states The 2022 edition of ICD-10-CM Z98. 89 became effective on October 1, 2021.
Since there is no regular CPT code for the procedure being performed at a cervical level, use the unlisted CPT code 22899 for a cervical kyphoplasty procedure.
000A for Wedge compression fracture of unspecified thoracic vertebra, initial encounter for closed fracture is a medical classification as listed by WHO under the range - Injury, poisoning and certain other consequences of external causes .
6: Pain in thoracic spine.
ICD-10 Code for Encounter for surgical aftercare following surgery on specified body systems- Z48. 81- Codify by AAPC.
Other specified postprocedural statesICD-10 code Z98. 89 for Other specified postprocedural states is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .
Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility. Z92. 82 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z92.
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.
For a vertebroplasty, physicians use image guidance, typically fluoroscopy, to inject a cement mixture into the fractured bone through a hollow needle. During kyphoplasty, a balloon is first inserted into the fractured bone through the hollow needle to create a cavity or space.
Percutaneous vertebral augmentation including cavity creation using mechanical device of one vertebral body must be reported with CPT codes 22513 (thoracic), 22514 (lumbar) and 22515 (each additional thoracic or lumbar vertebral body [list separately in addition to code for the primary procedure]).
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Title XVIII of the Social Security Act, §1833 (e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Vertebroplasty/Kyphoplasty L33473.
Use of these codes does not guarantee reimbursement. The patient’s medical record must document that the coverage criteria in this policy have been met.
All other ICD-10 codes not listed under “ICD-10 Codes that Support Medical Necessity” will be denied as not medically necessary.
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.