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Coding Tip of the Month

Presented by: Bracco Diagnostics Inc. Reimbursement Services
July 10, 2001


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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