How To Use HCPCS Code C7504

HCPCS code C7504 describes the procedure of percutaneous vertebroplasties, which includes bone biopsies when performed. This code is specifically used for the first cervicothoracic and any additional cervicothacic or lumbosacral vertebral bodies. It involves the injection of a substance into the vertebrae to treat fractures or other conditions. The procedure is performed unilaterally or bilaterally and includes all imaging guidance.

1. What is HCPCS C7504?

HCPCS code C7504 is used to identify the specific procedure of percutaneous vertebroplasties. It is important to note that this code is only applicable for the first cervicothoracic and any additional cervicothoracic or lumbosacral vertebral bodies. The code includes the injection of a substance into the vertebrae, as well as any bone biopsies that are performed during the procedure. This code is used to accurately document and bill for this specific medical intervention.

2. Official Description

The official description of HCPCS code C7504 is “Percutaneous vertebroplasties (bone biopsies included when performed), first cervicothoracic and any additional cervicothoracic or lumbosacral vertebral bodies, unilateral or bilateral injection, inclusive of all imaging guidance.” The short description for this code is “Enteral supp not otherwise c.”

3. Procedure

1. The provider begins the procedure by identifying the specific vertebrae that require treatment. This may involve reviewing imaging studies such as X-rays or MRIs.
2. The provider then prepares the patient for the procedure, ensuring that they are in a comfortable position and administering any necessary anesthesia or sedation.
3. Using imaging guidance, such as fluoroscopy, the provider inserts a needle into the targeted vertebrae.
4. A substance, typically a bone cement-like material, is injected into the vertebrae to stabilize fractures or treat other conditions.
5. If bone biopsies are necessary, the provider will perform them during the procedure, using the same needle or a separate needle.
6. After the injection and any biopsies are completed, the provider ensures that the needle is properly removed and applies any necessary dressings or bandages.

4. When to use HCPCS code C7504

HCPCS code C7504 should be used when performing percutaneous vertebroplasties on the first cervicothoracic and any additional cervicothoracic or lumbosacral vertebral bodies. It is important to accurately document the specific vertebrae involved in the procedure, as well as any bone biopsies that are performed. This code should only be used when the procedure is performed unilaterally or bilaterally and includes all imaging guidance.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code C7504, healthcare providers should ensure that they have proper documentation to support the procedure. This may include imaging studies, biopsy results, and a detailed description of the procedure performed. It is important to accurately code the specific vertebrae involved and indicate whether the procedure was performed unilaterally or bilaterally. Providers should follow the coding guidelines and documentation requirements set forth by the relevant insurance carriers and coding authorities.

6. Historical Information and Code Maintenance

HCPCS code C7504 was added to the Healthcare Common Procedure Coding System on January 01, 1985. It has an effective date of January 01, 1996. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This code falls under the category of percutaneous vertebroplasties and has remained unchanged since its addition to the HCPCS.

7. Medicare and Insurance Coverage

HCPCS code C7504 is eligible for coverage by Medicare and other insurance carriers. The pricing indicator code for this code is 57, which indicates that it is priced by other carriers. The multiple pricing indicator code is A, which means that it is not applicable as HCPCS priced under one methodology. Providers should refer to the Medicare Carriers Manual Reference Section Number 2130 for further guidance on billing and coverage for this code.

8. Examples

Here are five examples of when HCPCS code C7504 should be billed:

1. A patient presents with a compression fracture in the first cervicothoracic vertebra. The provider performs a percutaneous vertebroplasty, injecting bone cement into the affected vertebra.
2. A patient has multiple compression fractures in the cervicothoracic and lumbosacral vertebrae. The provider performs a bilateral percutaneous vertebroplasty, injecting bone cement into each affected vertebra.
3. A patient requires a bone biopsy of the first cervicothoracic vertebra. The provider performs a percutaneous vertebroplasty and includes the bone biopsy during the procedure.
4. A patient has a compression fracture in the first cervicothoracic vertebra and a separate compression fracture in the lumbosacral vertebra. The provider performs a unilateral percutaneous vertebroplasty on each affected vertebra.
5. A patient presents with severe osteoporosis and multiple compression fractures in the cervicothoracic and lumbosacral vertebrae. The provider performs a series of percutaneous vertebroplasties, injecting bone cement into each affected vertebra.