august 2011

Vertebroplasty vs. Vertebral Augmentation

Certain conditions such as osteoporosis or a compression fracture can cause the anterior boney portion of the vertebra to collapse leading to kyphosis (humping of the back) and back pain.  There are two similar methods that may be used for treating these conditions, one is a vertebroplasty to stabilize the compressed vertebra and the other is a vertebral augmentation also known as a “kyphoplasty” to restore the vertebral height.  Before discussing the individual procedures I want to quickly review some of the vertebral anatomy.  The poster portion of the vertebra is where you will find the spinous process, transverse process, facet joints and lamina.  The anterior portion of the vertebra is the front part of the rounded boney body that the posterior structures are attached to.  Both of the procedures that will be discussed are performed within the corpus or round shaped part of the vertebral body. 

VERTEBROPLASTY>

A cannula is inserted into the vertebral body through a percutaneous transpedicular (through the pedicle) approach and positioned in the anterior 1/3rd of the vertebral body using image guidance.  A special type of cement is mixed and then injected which will fill the porous spaces created by osteoporosis or fill the cracks caused by pathological fracturing.  

CPT code 22520 (thoracic) and 22521 (lumbar) are used for unilateral or bilateral injections at one level.  Additional levels are reported with the same add-on code 22522, regardless of whether it is a thoracic or lumbar procedure.  For injection(s) to the cervical area use HCPCS code S2360 for the initial level and S2361 for any additional levels.

VERTEBRAL AUGMENTATION

The term augmentation means “the act of increasing something”.  With a degenerative process of the vertebra, the anterior portion of the vertebral body can collapse, causing the bone to become compressed.  During an augmentation procedure a hole is drilled (unilaterally or bilaterally) and an expansion device such as a balloon is inserted into the defect and inflated.  This causes the compressed bone to increase in height restoring it back to its anatomical shape.  Once that has been accomplished the cement is injected into the defect and hardens, maintaining the increased height.

CPT code 22523 (thoracic) and 22524 (lumbar) are used for unilateral or bilateral injections at one level.  Additional levels are reported with the same add-on code 22525, regardless of whether it is a thoracic or lumbar procedure.  Also read the parenthetical notes for additional info. 

Image guidance for either of the above mentioned procedures would be reported as 72291-TC for fluoroscopy and 72292-TC for CT guidance.  Image guidance can be reported one time for each vertebral body per the CPT description, but carrier payment policies may differ and Medicare considers the radiological codes packaged into the primary service by placing these codes in N1 status, meaning no additional payment will be made to the facility.