How To Use CPT Code 22513

CPT 22513 is a code for percutaneous vertebral augmentation of the thoracic spine, including cavity creation, fracture reduction, and bone biopsy when performed. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 22513 procedures.

1. What is CPT 22513?

CPT 22513 is a medical billing code used to describe a percutaneous vertebral augmentation procedure, specifically for the thoracic spine. This procedure is performed to treat compression fractures of the spine and may include cavity creation, fracture reduction, and bone biopsy when necessary. The code is used by medical coders and billers to accurately document and bill for this specific procedure.

2. 22513 CPT code description

The official description of CPT code 22513 is: “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; thoracic.”

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. Under imaging guidance, either fluoroscopy or computed tomography, the provider percutaneously inserts a needle through the skin into a thoracic vertebral body.
3. A balloon is placed through the needle and into the vertebra.
4. The balloon is inflated to restore the height of the vertebra.
5. Bone cement is injected into the vertebral space to prevent future collapse.
6. The provider may inject one or both sides of the vertebra.
7. A bone biopsy may be performed by removing bone tissue for laboratory analysis while performing the procedure.

4. Qualifying circumstances

Patients eligible to receive CPT 22513 services are those who have been diagnosed with a compression fracture of the thoracic spine and require percutaneous vertebral augmentation to restore vertebral height and stabilize the fracture. This procedure may be necessary for patients experiencing severe pain, limited mobility, or other complications due to the compression fracture. The patient’s medical history, imaging studies, and other diagnostic tests should support the need for this procedure.

5. When to use CPT code 22513

CPT code 22513 should be used when a provider performs a percutaneous vertebral augmentation of the thoracic spine, including cavity creation, fracture reduction, and bone biopsy when performed. This code is appropriate for billing when the procedure is performed on a single thoracic vertebral body, with unilateral or bilateral cannulation, and includes all imaging guidance necessary for the procedure.

6. Documentation requirements

To support a claim for CPT 22513, the following information should be documented in the patient’s medical record:

• Patient’s medical history and physical examination findings
• Diagnostic imaging studies and other tests supporting the need for the procedure
• Indications for the procedure, including symptoms and functional limitations
• Details of the procedure performed, including the specific vertebral body treated, unilateral or bilateral cannulation, and any additional procedures such as bone biopsy
• Imaging guidance used during the procedure
• Postoperative care instructions and follow-up plan

7. Billing guidelines

When billing for CPT 22513, it is important to follow the appropriate guidelines and rules to ensure accurate reimbursement. Some tips for billing this code include:

• Ensure that the patient’s medical record contains the necessary documentation to support the claim, as outlined in the documentation requirements section.
• For each additional vertebral body treated, report add-on code 22515.
• If the same procedure is performed on the lumbar spine, use CPT code 22514 instead.
• Be aware of any payer-specific guidelines or requirements for billing this code.

8. Historical information

CPT 22513 was added to the Current Procedural Terminology system on January 1, 2015. There have been no updates to the code since its addition.

9. Similar codes to CPT 22513

There are several codes related to CPT 22513 that differentiate based on the specific procedure or location of the spine being treated. These include:

• CPT 22514: Similar to CPT 22513, but for the lumbar spine instead of the thoracic spine.
• CPT 22515: Add-on code for each additional vertebral body treated during the same session as CPT 22513 or 22514.
• CPT 22512: Percutaneous vertebral augmentation without the use of a mechanical device, such as vertebroplasty.
• CPT 22516: Percutaneous vertebral augmentation for the cervical spine.
• CPT 22517: Percutaneous vertebral augmentation for the sacral spine.

10. Examples

1. A patient with a compression fracture of the T7 vertebra undergoes percutaneous vertebral augmentation with kyphoplasty, unilateral cannulation, and imaging guidance.
2. A patient with compression fractures of the T5 and T6 vertebrae undergoes percutaneous vertebral augmentation with kyphoplasty, bilateral cannulation, imaging guidance, and bone biopsy for both levels.
3. A patient with a compression fracture of the T8 vertebra undergoes percutaneous vertebral augmentation with kyphoplasty, unilateral cannulation, imaging guidance, and bone biopsy.
4. A patient with a compression fracture of the T4 vertebra undergoes percutaneous vertebral augmentation with kyphoplasty, bilateral cannulation, and imaging guidance.
5. A patient with a compression fracture of the T9 vertebra undergoes percutaneous vertebral augmentation with kyphoplasty, unilateral cannulation, imaging guidance, and bone biopsy.
6. A patient with a compression fracture of the T3 vertebra undergoes percutaneous vertebral augmentation with kyphoplasty, bilateral cannulation, and imaging guidance.
7. A patient with a compression fracture of the T10 vertebra undergoes percutaneous vertebral augmentation with kyphoplasty, unilateral cannulation, imaging guidance, and bone biopsy.
8. A patient with a compression fracture of the T2 vertebra undergoes percutaneous vertebral augmentation with kyphoplasty, bilateral cannulation, and imaging guidance.
9. A patient with a compression fracture of the T11 vertebra undergoes percutaneous vertebral augmentation with kyphoplasty, unilateral cannulation, imaging guidance, and bone biopsy.
10. A patient with a compression fracture of the T1 vertebra undergoes percutaneous vertebral augmentation with kyphoplasty, bilateral cannulation, and imaging guidance.