(2023) How To Bill Kyphoplasty CPT Codes 22513, 22514 & CPT 22515

Kyphoplasty, also referred to as augmentation, can be reported with CPT code 22513 CPT 22514 and CPT 22515. You can find the explanations of these CPT codes and the billing instructions, for the kyphoplasty CPT codes below.

What is Kyphoplasty?

To treat a body, doctors may perform a surgical procedure called kyphoplasty. This involves implanting bone tamp (IBT) into the broken bone.

According to AAPC, it is recommended to use bone cement to fill the resulting cavity. Vertebral compression fractures (VCFs) are commonly corrected through kyphoplasty surgery.

These fractures are often caused by osteoporosis. It can also be a result of other disorders. The treatment involves inserting a device into the vertebral body, inflating it and creating space for the spinal cord to heal. The gap can be filled with bone cement to stabilize the pain.

CPT 22513  

CPT 22513 is used for a procedure called thoracic augmentation, where a mechanical device works on one vertebral body and creates a cavity through unilateral or bilateral cannulation.

CPT 22514  

For Lumbar augmentation CPT 22514 involves the use of a mechanical device.

CPT 22515  

CPT 22525 is applicable when there is a need for cannulation of a thoracic or lumbar vertebral body unilaterally or bilaterally for vertebral augmentation with cavity creation. If this procedure is performed successfully, it includes reduction and bone biopsy using a device like a kyphoplasty.

Billing Guidelines for Kyphoplasty

The augmentation procedure requires using specific CPT codes, namely 22513 for thoracic, 22514 for lumbar, and 22515 as an add-on code. These codes are necessary to document and report the creation of a cavity within a body using a mechanical device. According to American Medical Coding, CPT code 22515 cannot be used alone; codes must accompany it.

When documenting a bone biopsy performed in an area than usual, it is important to include either modifier 59 or modifier XS with the Kyphoplasty CPT code.

These modifiers indicate that the biopsy was done on a structure or at another site. This information should be provided in box 19 of the CMS 1500 form or its electronic equivalent, like L1.

It’s worth noting that insurance will cover all expenses related to vertebroplasty and vertebral augmentation treatments, including venography and injections. There is no need to file a payment or additional bill for venography during the surgical session.

In the Medicare Physician Fee Schedule Database, procedures such as vertebroplasty and percutaneous vertebral augmentation (kyphoplasty) are assigned an “assistant at surgery” indicator value of “1”. This means no surgical assistant can receive compensation for their time during these procedures due to restrictions.

According to the guidelines set by the Current Procedural Terminology (CPT) when coding for kyphoplasty procedures, it is essential to note that the codes encompass steps. These steps include gaining access to the fracture site inflating the balloon inserting the bone cement and utilizing any imaging guidance. It is not necessary to bill for fluoroscopy or any other imaging procedures.

Example 1

Patient: A 66-year woman experiencing back pain after a fall on the staircase of her home. An MRI revealed acute compression fractures in the bodies of L1 and L2, which were caused by osteoporosis.

Procedure: To provide stability, the doctor conducted kyphoplasty on the vertebrae in the L1 and L2 regions. This involved using balloon tamps to expand the areas injecting bone cement while guided by imaging technology, and ensuring that the height of the bodies was restored. The entire operation took 85 minutes.

Billing: For the kyphoplasty procedure on the first vertebral body, CPT 22513 was billed and 22514 for the second one.

Example 2

Patient: A woman, aged 72, comes in with a compression fracture of the T7 and T8 vertebrae following a fall.

Procedure: An MRI scan confirms that the fractures occurred due to her existing osteoporosis. The doctor decides to perform kyphoplasty on the bodies of T7 and T8 to stabilize the fractures.

Billing: The appropriate Kyphoplasty CPT codes in this case are 22513 and 22515.

Sources

1. https://www.cms.gov/medicare-coverage-database/view/technology-assessments.aspx?TAId=25
2. https://www.aapc.com/codes/cpt-codes/22514
3. https://www.beckersasc.com/asc-coding-billing-and-collections/surgery-center-coding-guidance-kyphoplasty-procedures.html