REIMBURSEMENT LANDSCAPE
Since 2006, technology has evolved that impacts traditional kyphoplasty coding. Initially kyphoplasty was defined as the “balloon procedure”. Today, there are additional technologies designed for cavity creation in the treatment of vertebral compression fractures. Consequently, coding language is evolving as well.
One example, CMS has released language changes in its final inpatient prospective payment rule (IPPS) effective October 1, 2008. In the ICD-9-CM procedure code addendum, the Agency has provided the following revisions to their coding language for kyphoplasty: (ICD-9 CM 2009 Volumes 1&2)
ICD-9 Code |
Fiscal Year |
Code Title |
Description |
81.66 |
2008 |
Kyphoplasty |
Insertion of inflatable balloon, bone tamp, or other device to create a space |
2009 |
Percutaneous vertebral augmentation |
|
The CPT codes and corresponding APC codes for vertebral augmentation are provided below.
CPT Code |
Description |
Ambulatory Payment Classification (APC) |
22523 |
Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, one vertebral body, unilateral or bilateral cannulation (eg, kyphoplasty); thoracic |
APC 0052 |
22524 |
Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, one vertebral body, unilateral or bilateral cannulation (eg, kyphoplasty); lumbar |
APC 0052 |
22525 |
each additional thoracic or lumbar vertebral body |
APC 0052 |
