How To Use CPT Code 22511

CPT code 22511 describes the percutaneous vertebroplasty procedure, which involves the injection of bone cement into a fractured vertebra in the lumbosacral spine. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 22511?

CPT 22511 is used to describe the percutaneous vertebroplasty procedure, which is performed to repair a fractured vertebra in the lumbosacral (lower) spine. During this procedure, a qualified healthcare provider injects bone cement into the affected vertebra to stabilize it and relieve pain. The procedure may also include a bone biopsy for diagnostic purposes.

2. Official Description

The official description of CPT code 22511 is: ‘Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance lumbosacral.’

3. Procedure

The percutaneous vertebroplasty procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The healthcare provider performs an injection through the skin into the lumbosacral area using a substance such as methyl methacrylate, a type of acrylic cement.
3. The injection is guided by imaging, either fluoroscopy or computed tomography (CT), to ensure accurate placement of the cement.
4. The provider may inject one or both sides of the vertebra, depending on the specific case.
5. During the procedure, the provider may also perform a bone biopsy by removing bone tissue for laboratory analysis.

4. Qualifying circumstances

Patients who may require CPT 22511 are those with a fractured vertebra in the lumbosacral spine, typically due to osteoporotic compression fractures. Conservative treatment options must have been attempted and failed before considering percutaneous vertebroplasty. The procedure is performed by a qualified healthcare provider under imaging guidance, either fluoroscopy or CT.

5. When to use CPT code 22511

CPT code 22511 should be used when a qualified healthcare provider performs percutaneous vertebroplasty on a single vertebral body in the lumbosacral spine. It is important to note that this code is specific to the lumbosacral region and should not be used for procedures performed on other areas of the spine.

6. Documentation requirements

To support a claim for CPT 22511, the healthcare provider must document the following information:

• Patient’s diagnosis of a fractured vertebra in the lumbosacral spine
• Details of the percutaneous vertebroplasty procedure, including the use of bone cement and any bone biopsy performed
• Date of the procedure
• Imaging guidance used (fluoroscopy or CT)
• Side(s) of the vertebra injected
• Any complications or additional procedures performed
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 22511, ensure that the procedure meets the specific criteria outlined in the code description. It is important to note that CPT code 22511 includes the bone biopsy when performed. If the procedure involves additional vertebral bodies, report the add-on code 22512 for each additional vertebral body. It is also important to use the appropriate modifiers, such as modifier 50 for bilateral procedures.

8. Historical information

CPT code 22511 was added to the Current Procedural Terminology system on January 1, 2015. There have been no updates to the code since its addition.

9. Examples

1. A 65-year-old patient with osteoporosis undergoes percutaneous vertebroplasty on a fractured vertebra in the lumbosacral spine.
2. A 70-year-old patient with a compression fracture in the lumbosacral spine undergoes percutaneous vertebroplasty with a bone biopsy for diagnostic purposes.
3. A 55-year-old patient with severe back pain due to a fractured vertebra in the lumbosacral spine undergoes percutaneous vertebroplasty on both sides of the vertebra.
4. A 60-year-old patient with multiple osteoporotic compression fractures in the lumbosacral spine undergoes percutaneous vertebroplasty on three vertebral bodies, using CPT code 22512 for the additional bodies.
5. A 75-year-old patient with a suspected malignant lesion in the lumbosacral spine undergoes percutaneous vertebroplasty with a bone biopsy for pathological analysis.