JUNE 2015

2015 Changes to Spine Procedures

Percutaneous Vertebroplasty 22510-22512

These codes are new in 2015 and along with the primary procedure the code descriptor also includes a bone biopsy when it is performed and “all imaging guidance”. Another departure from the norm is that throughout the CPT manual we have codes sets that are reported based on whether the service was performed in the cervical or thoracic regions as opposed to the lumbar or sacral regions. The terminology now being used for this code set references the regions as cervicothoracic (22510) or lumbosacral (22511) with both codes using the same add-on code 22512 for each additional level.

Percutaneous Vertebral Augmentation 22513-22515

These codes are new in 2015 and along with the primary procedure the code descriptor also includes creation of cavity, fracture reduction, bone biopsy and all imaging guidance, however there are only codes for the thoracic region (22513) and lumbar region (22514) with both codes using the same add-on code 22515.

Sacroplasty

A sacroplasty is reported using Category III codes 0200T and 0201T which were revised in 2015 to now include both imaging guidance and bone biopsy when performed – services that were additionally reported in previous years. Due to the fact that image guidance is now included with all percutaneous vertebroplasty and vertebral augmentation procedures the CPT codes 72291/72292 (which were used for imaging) have been deleted.

CPT Assistant Apr. 2015

This CPT Assistant was published to correct an error in the Category III sacroplasty codes. In the code descriptor it states “including the use of a balloon or mechanical device, when used” suggesting that even when a cavity is not created you would still use Category III codes for injection of cement alone. This is incorrect. With the establishment of the new code sets you would report CPT code 22511 percutaneous vertebroplasty (lumbosacral) for injection of cement without cavity creation.

AMA and CCI Edit Guidelines

Spinal code sets have what CMS refers to as “Families of Codes” meaning that although you have primary codes for different regions all of those primary codes use the same add-on code. When reporting these services you only report one primary code (based on the first level treated) and then each additional level(s) is reported using an add-on code(s) even when the procedure is performed in both the thoracic and lumbar levels during the same operative session. This applies to AMA and Medicare/CMS guidelines. For example: T12 is the first level treated you would report 22510 or 22513. The physician then goes on to treat the L1 and L2 levels. These additional levels are reported with the appropriate add-on codes even though they are lumbar and not thoracic. It would be incorrect to report another primary code for the first lumbar level and then the additional add-on code.

 

 







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