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Pedicle Augmentation

Caralee Posted Fri 15th of September, 2017 23:48:51 PM
Pt, has pseudarthrosis at L4-S1 from surgery. Surgeon removed the screws and hardware from L4-S1 and performed L3-S1 lumbar fusion. Due to poor quality of bone and pseudarthrosis , pedicle augmentation with hydroxyapatite using kyphoplasty technique was done when placing hardware for L3-S1 fusion. . There is no fracture noted in op reports Since Medicare LCD lists only fracture codes for kyphoplasty, is there any codes that we can use to bill for kyphoplasty and/or pedicle augmentation work? Thank you.
SuperCoder Answered Mon 18th of September, 2017 05:20:50 AM


As per Medicare LCD related to kyphoplasty: malignancy, neoplasm, collapsed vertebra and fractures codes are covered as "Support Medical Necessity" category. But, there are no codes are mentioned in "DO NOT Support Medical Necessity" category. Hence, without worry you can bill your diagnosis code for which you have performed the surgery, just you need to show the medical necessity for the procedure.

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