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Coding Tip of the Month
Presented by: Bracco Diagnostics Inc. Reimbursement Services
July 10, 2001
Issue: VERTEBROPLASTY
Background:
Osteoporosis is a major health problem for seniors. As a result of osteoporosis,
nearly 700,000 fractures are diagnosed every year. Vertebroplasty is used
to treat painful compression fractures that are unresponsive to medical
treatment. Vertebroplasty is also performed in cases of vertebral metastases,
myeloma, and traumatic fractures.
The procedure is considered "non-invasive" as it does not require
a surgical incision. An interventional radiologist or neuro-radiologist
generally performs the procedure. The patient is given local anesthesia
or conscious sedation. A needle is then placed into the affected vertebra
under radiological guidance. A venogram is frequently performed at this
time. Bone cement is slowly injected until the desired affect is accomplished.
It may take up to one hour for each vertebra injected. Ninety (90) percent
of the patients undergoing this procedure acquire relief within 24 hours.
Current Status:
As of January 1st 2001, the AMA CPT book has included the following
codes for the vertebroplasty procedure:
| 22520 Percutaneous vertebroplasty, 1 vertebral body,
unilateral or bilateral, thoracic |
| 22521 Percutaneous vertebroplasty, 1 vertebral body,
unilateral or bilateral, lumbar |
| 76012 Radiological supervision and interpretation, vertebroplasty,
per vertebral body fluoroscopic guidance |
| 76013 Radiological supervision and interpretation, vertebroplasty,
per vertebral body CT guidance |
Procedures performed prior to January, 2001, were billed as unlisted
procedures.
Coding should include a radiological and "surgical code" in
order to report the complete procedure. You should also be careful to
code for any other procedure performed, i.e. venogram, conscious sedation,
and any monitoring other than that required for the procedure and anesthesia
type.
Medical necessity should be clearly documented. It should
reveal the patients’ pertinent history including the failed attempt(s)
for medical management. Medicare does not consider this procedure
covered as a prophylactic measure or to treat chronic pain issues.
If reported by hospital outpatient facilities, this procedure will fall
under APC 0274.
Payment for each vertebral body is approximately $450- $520 depending
on geographic indices.
The following diagnosis codes are considered by Medicare to support medical
necessity:
| 170.2 Malignant neoplasm of vertebral column, excluding
sacrum and coccyx |
| 198.5 Secondary malignant neoplasm of bone and bone marrow |
| 203.00 Multiple myeloma, without mention of remission |
| 203.01 in remission |
| 228.09 Hemangioma of other sites |
| 238.0 Neoplasm of uncertain behavior of other and
unspecified sites and tissues, bone and articular cartilage |
| 238.6 plasma cells |
| 239.2 Neoplasms of unspecified nature, bone, soft tissue,
and skin |
| 277.8 Other specified disorders of metabolism |
| 733.13 Pathologic fracture of vertebrae |
It is the responsibility of the provider to code to the highest level
specified in the ICD-9-CM (e.g., to the fourth or fifth
digit). The correct use of an ICD-9-CM code listed above does not
assure coverage of a service. The service must be reasonable and necessary
in the specific case and must meet the criteria specified in the policy.
Revenue codes acceptable are: 36X, 49X, or 76X.
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