How To Use CPT Code 22514

CPT 22514 refers to a percutaneous vertebral augmentation procedure, such as kyphoplasty, performed on the lumbar spine. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 22514.

1. What is CPT 22514?

CPT 22514 is a medical code used to describe a percutaneous vertebral augmentation procedure, specifically for the lumbar spine. This procedure is commonly known as kyphoplasty and is used to treat compression fractures of the spine. It may also include fracture reduction and bone biopsy when performed. The procedure is performed under imaging guidance, such as fluoroscopy or computed tomography.

2. 22514 CPT code description

The official description of CPT code 22514 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; lumbar.”

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. The provider percutaneously inserts a needle through the skin under imaging guidance, either fluoroscopy or computed tomography, into a lumbar vertebral body.
3. A balloon is placed through the needle, into the vertebra, and then inflated to restore the height of the vertebra.
4. Bone cement is injected into the vertebral space to ensure it does not collapse again.
5. The provider may inject one or both sides of the vertebra.
6. 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 22514 services are those who have been diagnosed with compression fractures of the lumbar spine. These fractures may be caused by osteoporosis, trauma, or other underlying conditions that weaken the vertebral body. The procedure is typically recommended for patients who have not responded to conservative treatments, such as pain medications, rest, and bracing, or for those who are experiencing severe pain, disability, or spinal deformity due to the compression fracture.

5. When to use CPT code 22514

It is appropriate to bill the 22514 CPT code when a provider performs a percutaneous vertebral augmentation procedure on the lumbar spine, such as kyphoplasty, to treat a compression fracture. This code should be used when the procedure includes cavity creation, fracture reduction, and bone biopsy (when performed), unilateral or bilateral cannulation, and imaging guidance.

6. Documentation requirements

To support a claim for CPT 22514, the following information should be documented in the patient’s medical record:

• Indication for the procedure, including the diagnosis of a lumbar compression fracture and the failure of conservative treatments.
• Details of the procedure performed, including the use of imaging guidance, the specific vertebral body treated, and whether unilateral or bilateral cannulation was performed.
• Any additional procedures performed during the same session, such as fracture reduction or bone biopsy.
• Post-procedure imaging to confirm the correct placement of the bone cement and the restoration of vertebral height.
• Documentation of the patient’s response to the procedure, including any improvements in pain, function, or spinal alignment.

7. Billing guidelines

When billing for CPT code 22514, it is important to follow the specific guidelines and rules set forth by the payer. Some general tips for billing this code include:

• Ensure that all required documentation is present in the patient’s medical record to support the claim.
• Use appropriate modifiers when necessary, such as when billing for bilateral procedures or when multiple procedures are performed during the same session.
• Be aware of any payer-specific rules or policies regarding the use of CPT 22514, as these may vary between payers.

8. Historical information

CPT 22514 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 22514

Five similar codes to CPT 22514 include:

• CPT 22513: This code is used for percutaneous vertebral augmentation procedures performed on the thoracic spine.
• CPT 22515: This code is used for each additional lumbar vertebral body treated during the same session as CPT 22514.
• CPT 22516: This code is used for percutaneous vertebral augmentation procedures performed on the cervical spine.
• CPT 22517: This code is used for each additional cervical vertebral body treated during the same session as CPT 22516.
• CPT 22518: This code is used for each additional thoracic vertebral body treated during the same session as CPT 22513.

10. Examples

Here are 10 detailed examples of CPT code 22514 procedures:

1. A 65-year-old female with osteoporosis presents with a painful lumbar compression fracture that has not responded to conservative treatments. The provider performs a kyphoplasty on the L3 vertebral body under fluoroscopic guidance.
2. A 75-year-old male with a history of multiple myeloma presents with a pathological fracture of the L2 vertebral body. The provider performs a percutaneous vertebral augmentation with bilateral cannulation and bone biopsy for diagnostic purposes.
3. A 55-year-old female with a traumatic lumbar compression fracture undergoes a kyphoplasty on the L4 vertebral body under computed tomography guidance.
4. A 70-year-old male with severe osteoporosis presents with multiple lumbar compression fractures. The provider performs a kyphoplasty on the L1 and L2 vertebral bodies during the same session, using CPT 22514 for the first vertebral body and CPT 22515 for the second.
5. A 60-year-old female with a painful lumbar compression fracture undergoes a percutaneous vertebral augmentation with unilateral cannulation and fracture reduction under fluoroscopic guidance.
6. A 67-year-old male with a history of spinal metastases presents with a pathological fracture of the L5 vertebral body. The provider performs a kyphoplasty with bone biopsy for diagnostic purposes.
7. A 72-year-old female with a painful lumbar compression fracture undergoes a percutaneous vertebral augmentation with bilateral cannulation and fracture reduction under computed tomography guidance.
8. A 63-year-old male with a history of spinal metastases presents with a pathological fracture of the L1 vertebral body. The provider performs a kyphoplasty with unilateral cannulation and bone biopsy for diagnostic purposes.
9. A 58-year-old female with a traumatic lumbar compression fracture undergoes a kyphoplasty on the L3 vertebral body under fluoroscopic guidance and fracture reduction.
10. A 76-year-old male with severe osteoporosis presents with multiple lumbar compression fractures. The provider performs a kyphoplasty on the L4 and L5 vertebral bodies during the same session, using CPT 22514 for the first vertebral body and CPT 22515 for the second.