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Orthopedic Coding Alert

Reader Questions:

Don't Stop Reading Op Report Halfway Through

Question: Our surgeon performed a complete T7 and partial T6 corpectomy with vertebroplasty, followed by spine stabilization using pedicle screws. I submitted 63087 for the corpectomy, 63088 for the additional-level corpectomy, 22899 for the vertebroplasty and 22842 for pedicle screw instrumentation. Medicare denied the 22842, saying that this was an add-on code for which we did not provide a primary procedure. Is this correct?

Texas Subscriber

Answer: Based on your description, you correctly reported 63087 (Vertebral corpectomy [vertebral body resection], partial or complete, combined thoracolumbar approach with decompression of spinal cord, cauda equina or nerve root[s], lower thoracic or lumbar; single segment) and +63088 (... each additional segment [list separately in addition to code for primary procedure]) for the T7/partial T6 corpectomy. Your payer's denial most likely stems from your use of 22899 (Unlisted procedure, spine) to describe the "vertebroplasty."

Various practitioners and insurers provide different meanings for vertebroplasty, which can be a fairly generic term. Therefore, you should be especially sure to read the entire operative note (rather than just the "procedures performed" header) and, if necessary, speak to the surgeon to determine exactly what he did.
Most surgeons define vertebroplasty as injecting medical-grade bone cement (PMMA) under radiological guidance into a compressed vertebra. The cement typically hardens in 15 minutes to an hour, thereby stabilizing the vertebra. CPT contains three codes to describe vertebroplasty, depending on the area(s) the surgeon treats:
  22520 - Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic
  22521 - ... lumbar
  +22522 - ... each additional thoracic or lumbar vertebral body (list separately in addition to code for primary procedure). In your case, however, the surgeon more likely performed spinal fusion and reconstruction (which some surgeons may also refer to as vertebroplasty, but is defined in CPT as arthrodesis).

Because your surgeon used a thoracolumbar approach, you should report 22610 (Arthrodesis, posterior or posterolateral technique, single level; thoracic [with or without lateral transverse technique]) for the initial (T6-T7) level and +22614 (... each additional vertebral segment [list separately in addition to code for primary procedure]) for the additional (T7-T8) level.

If, in fact, the surgeon performed arthrodesis as described by 22610/22614, you may properly report 22842 (Posterior segmental instrumentation [e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires]; 3 to 6 vertebral segments) to describe the pedicle screw instrumentation. Medicare payers will accept the arthrodesis (22610) as the primary code for the instrumentation.

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