Coding for Vertebral Compression Fracture Procedures

Several technologies exist for vertebral augmentation in the treatment of vertebral compression fractures, including Radiofrequency-Targeted Vertebral Augmentation™ (RF-TVA™), also referred to as RF Kyphoplasty. The coding language in the United States has evolved to include all FDA cleared devices that displace, remove, or compact bone to create a space, cavity, or void.*

Vertebral Augmentation (formerly Kyphoplasty) Coding: Effective October 1, 2008 (ICD-9 CM 2010 Volumes 1 & 2)

ICD-9 Code Fiscal Year ICD-9 Code Title ICD-9 Code Description
81.66 2010 Percutaneous vertebral augmentation Insertion of inflatable balloon, bone tamp, or other device displacing (removing) (compacting) bone to create a space (cavity) (void) prior to the injection of bone void filler (cement) (polymethylmethacrylate) (PMMA) or other substance. Arcuplasty, Kyphoplasty, SKyphoplasty, Spineoplasty.*

Product specific terms given as examples that were commercially available at the time of publication

CPT codes and corresponding APC codes for vertebral augmentation

CPT Code 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

*The reimbursement language herein replaces previously used terms, including, but not limited to, kyphoplasty reimbursement, kyphoplasty ICD 9 code, and kyphoplasty CPT code.

*Disclaimer: Providers are ultimately responsible for determining the appropriate codes, coverage, and payment for individual patients. DFINE does not guarantee third party coverage or payment for DFINE products. DFINE makes no representation or warranty regarding the completeness, accuracy or timeliness of information as payer policies are complex and change frequently. DFINE recommends contacting the third party or governmental payer to verify correct coverage, coding and billing for medical procedures and products
.
 

Coding Guidelines

Reimbursement Landscape