Becker's Spine Review

14 Executive Briefing: Coding Updates for Sacroplasty in 2015 By Laura Dydra T he American Medical Associa- tion changed the language in the Category I CPT codes for ver- tebroplasty effective January 1, 2015. The update added sacral and cervical to the applicable vertebroplasty code descriptors and included changes to the code numbers and bundled imag- ing, moderate sedation and the use of bone biopsy for the procedures. "Initially they were just reviewing the imaging and bone biopsy bun- dle, but at the meeting they discussed whether there was enough clinical data to substantiate adding sacral and cervical language to the Category I CPT codes," says Cindy Vandenbosch, a medical device reimbursement consul- tant with Strategic Reimbursement Consulting. "In making these changes, they've defined the clinical difference between sacral vertebral augmentation and sacral vertebroplasty. It's import- ant for physicians to understand these changes and code the procedures correctly." Here is a quick overview of the changes: 1. Vertebroplasty codes 22520 to 22522, 72291 and 72292 were deleted; the codes 22510 to 22512 were added. The new codes include image guidance. 2. Vertebral augmentation codes 22513 to 22515 were added to also include the bundled image guidance. The codes contin- ue to include bone biopsy and conscious sedation. 3. Avoid using two primary codes when coding the same pro- cedure. 4. There are new add-on codes for physicians performing per- cutaneous vertebroplasty at two vertebral bodies. 5. The primary location would be the cervicothoracic spine and the secondary vertebral body is the cervicothoracic or lumbar spine. Much in the way lumbar vertebral augmentation was initial- ly referred to as "kyphoplasty", "sacroplasty" has been a market- ing term used for treatment of vertebral compression fractures of the sacrum. Many physicians refer to both vertebroplasty of the sacrum and sacral vertebral augmentation as "sacroplasty." There has been significant confusion about what procedures are performed and how to differentiate coding as a result. "Physicians historically coded these procedures as sac- roplasty and used the Category III code but now there is a clin- ical differentiation. The AMA stepped up and clarified coding and descriptions for these procedures," says Ms. Vandenbosch. "There is one code for sacroplasty or sacral vertebral augmen- tation, which is creating the cavity and injecting cement, and a separate code for sacral vertebroplasty, which describes injec- tion of the cement only. Be certain the operative notes reflect what is actually being done during the procedure so that the appropriate code can be identified by the coder." It is important to keep in mind that a Category I CPT code doesn't mean the procedure is covered and paid by payors. Pay attention to the payer's specific coverage guidelines. Some payers may not make the same distinction as the AMA. Addi- tionally, Medicare coverage is MAC-specific, meaning there are variations from one region to the next. The MACs are always revising their coverage criteria and it is important providers review their relevant coverage guidelines on a regular basis. "It's critical physicians review their local MAC coverage guidelines for these procedures," says Ms. Vandenbosch. "Some MACs are very specific about treatment of the sacrum, others list sacroplasty as investigational and experimental as a result of the Category III CPT Code assignment, and others are silent regarding coverage of these procedures in the sacrum. Spend the time to understand your specific conditions of cover- age." References can be found at helpingbacks.com/footnotes n 1000-025-478 Rev A CPT copyright 2015 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Sponsored by: Stryker is one of the world's leading medical technology companies and together with our customers, we are driven to make healthcare better. The Company offers a diverse array of innovative products and services in Orthopaedics, Medical and Surgical, and Neurotechnology and Spine, which help improve patient and hospital outcomes. Stryker is active in over 100 countries around the world. Please contact us for more information at www.stryker.com. Coding Updates for Sacroplasty in 2015 Cindy Vandenbosch

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