When ICD-10 codes C90.00 or C90.01, multiple myeloma, are used to bill for percutaneous vertebroplasty, the patient’s medical record must document the presence of severe back pain related to a destruction of the vertebral body, not involving the major part of the cortical bone.
2021 ICD-10-PCS Procedure Code 0QU03JZ Supplement Lumbar Vertebra with Synthetic Substitute, Percutaneous Approach 2016 2017 2018 2019 2020 2021 Billable/Specific Code ICD-10-PCS 0QU03JZ is a specific/billable code that can be used to indicate a procedure.
When ICD-10 code D18.09, hemangioma of other specified sites, are used to bill for percutaneous vertebroplasty, the patient’s medical record must document the presence of hemangioma of the spine that has resulted in severe pain or aggressive clinical signs (nerve compression). Percutaneous Sacroplasty (0200T, 0201T)
Proper coding is 22510, 22512. Note that 22510-22512 describe unilateral or bilateral procedures. Do not append modifier 50 Bilateral procedure (or expect additional reimbursement) if the physician injects the same vertebral body multiple times.
New codes and introductory language that became effective January 1, 2015 to describe percutaneous treatment of vertebral fractures have raised questions from users, which this article attempts to address. These new codes include the bundling of all imaging required to perform the procedure, moderate sedation, and bone biopsy when performed.
*Use ICD-10-CM code M85. 80, M85.
The CPT code for sacral vertebroplasty (without cavity creation) is 22511. The CPT codes for sacral vertebral augmentation that include cavity creation are Category III codes 0200T and 0201T.
Wedge compression fracture of first lumbar vertebra, initial encounter for closed fracture. S32. 010A 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 S32.
22511. PERCUTANEOUS VERTEBROPLASTY (BONE BIOPSY INCLUDED WHEN PERFORMED), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION, INCLUSIVE OF ALL IMAGING GUIDANCE; LUMBOSACRAL.
Vertebroplasty and kyphoplasty are relatively new techniques for the treatment of pain caused by vertebral body compression fractures. Kyphoplasty differs from vertebroplasty in that a balloon is first inflated in the vertebral body to create a cavity into which cement is then injected under lower pressure.
Percutaneous vertebral augmentation (PVA) is a minimally invasive procedure for the treatment of compression fractures of the vertebral body. The procedure includes the creation of a cavity which results in fracture reduction along with an attempt to restore vertebral body height and alignment.
The most common type of compression fracture is a wedge fracture, in which the front of the vertebral body collapses but the back does not, meaning that the bone assumes a wedge shape. Sometimes, more than one vertebra fractures, a condition called multiple compression fractures.
In ICD-10-CM, codes for compression and pathologic fractures of the spine (not due to trauma) are located in Chapter 13, Diseases of the Musculoskeletal System and Connective Tissue. Category M48. 5-, Collapsed vertebra, not elsewhere classifiable is used for vertebrae fracture where no cause is listed.
Wedge compression fracture of third lumbar vertebra, initial encounter for closed fracture. S32. 030A 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 S32.
What is a vertebral augmentation? Percutaneous vertebroplasty is a minimally invasive procedure in which cement designed for use in bones is injected into the vertebral column (spine). You may be recommended for this procedure if you are suffering from pain caused by a vertebral compression fracture.
CPT® 22512, Under Percutaneous Vertebroplasty and Vertebral Augmentation Procedures. The Current Procedural Terminology (CPT®) code 22512 as maintained by American Medical Association, is a medical procedural code under the range - Percutaneous Vertebroplasty and Vertebral Augmentation Procedures.
Coverage will be provided for Percutaneous Vertebroplasty or Percutaneous Vertebral Augmentation when it is determined to be medically necessary because the medical criteria and guidelines shown below are met. Please refer to the member's individual Evidence of Coverage (EOC) for benefits.
Code 22515 is an add-on code used to report vertebral augmentation for each additional vertebral body treated in the thoracolumbar spine during the same therapeutic session (22513 or 22514 is reported once for a single session, and these two codes are never reported together).
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® 22512, Under Percutaneous Vertebroplasty and Vertebral Augmentation Procedures. The Current Procedural Terminology (CPT®) code 22512 as maintained by American Medical Association, is a medical procedural code under the range - Percutaneous Vertebroplasty and Vertebral Augmentation Procedures.
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.
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.
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. American Medical Association. All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the American Medical Association (AMA).
CPT is provided “as is” without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon no upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.
For example, a surgeon documents bilateral percutaneous vertebroplasty at vertebral segments T12 and L1. Proper coding is 22510, 22512.
When reporting vertebroplasty, code selection depends on the location and number of vertebral bodies treated. Choose a single “initial level” code based on the location of the first vertebral body treated:
Percutaneous vertebroplasty codes include the two procedures most commonly performed during the same session—imaging guidance and bone biopsy (e.g., Biopsy, bone, trocark or needle; deep (eg, vertebral body, femur)—and therefore you may not code seperately for them at the same level.
Kyphoplasty Is Like Vertebroplasty “Plus”. Percutaneous vertebral augmentation (a.k.a., kyphoplasty or balloon-assisted percutaneous vertebroplasty ) is a similar to vertebroplasty, but includes the use of an inflatable balloon to “jack up” the damaged vertebra (e) prior to methylmethacrylate injection.
General guidelines B4.1a If a procedure is performed on a portion of a body part that does not have a separate body part value, code the body part value corresponding to the whole body part.
A1 ICD-10-PCS codes are composed of seven characters. Each character is an axis of classification that specifies information about the procedure performed. Within a defined code range, a character specifies the same type of information in that axis of classification.
When section X contains a code title which fully describes a specific new technology procedure, and it is the only procedure performed , only the section X code is reported for the procedure. There is no need to report an additional code in another section of ICD-10-PCS. Example: XW04321 Introduction of Ceftazidime-Avibactam Anti-infective into Central Vein, Percutaneous Approach, New Technology Group 1, can be coded to indicate that Ceftazidime-Avibactam Anti-infective was administered via a central vein. A separate code from table 3E0 in the Administration section of ICD-10-PCS is not coded in addition to this code.
No attempt to restore vertebral height or create a cavity for the cement is made with vertebroplasty. Code 22510 is reported for the initial cervical or thoracic vertebral body treated with vertebroplasty. Vertebroplasty performed to treat the initial lumbosacral vertebral body is reported with 22511. 22510 and 22511 are primary codes, and only one of these codes may be reported during a single session (both of these codes would not be reported together). Add-on code 22512 is used to report vertebroplasty performed on each additional level during the same session, regardless of whether the additional level is cervical, thoracic, lumbar, or sacral.
Vertebroplasty performed to treat the initial lumbosacral vertebral body is reported with 22511. 22510 and 22511 are primary codes, and only one of these codes may be reported during a single session (both of these codes would not be reported together).
A vertebroplasty is performed at T7 using bilateral transpedicular needle placement and injection of cement. A second level (L2) is treated with vertebroplasty also, using bilateral transpedicular needle placement with cement injection. A combination of fluoroscopic and CT guidance is used.
A vertebral augmentation procedure attempts to restore height to a fractured vertebral body in addition to stabilizing the fracture . This is done by mechanical creation of a cavity within the vertebral body (for example, using a balloon, peek implant, or curette), followed by injection of cement into the cavity.
Each Category I code (22510-22515) includes unilateral and bilateral injections, while the Category III codes for sacral augmentation specify unilateral (0200T) or bilateral (0201T) injection. In addition to bundling imaging with the surgical codes, the new codes for 2015 also changed sacral vertebroplasty from Category III level codes to Category I code 22511, and cervical vertebroplasty to Category I code 22510. Sacral vertebral augmentation continues to be reported with a Category III code (0200T, 0201T). Cervical vertebral augmentation is reported with unlisted code 22899.
Bilateral transpedicular needle placement is performed at T7. An aspiration biopsy of the vertebral body is performed, followed by bilateral injection of cement. CT guidance is used.
New codes and introductory language that became effective January 1, 2015 to describe percutaneous treatment of vertebral fractures have raised questions from users, which this article attempts to address.