A vertebral augmentation or kyphoplasty procedure is used to stabilize the vertebra after a compression fracture where the anterior portion of the vertebral body is collapsed. In this procedure drill holes are made either unilaterally or bilaterally from a posterior approach to the area of vertebral collapse. A balloon dilation/expansion device is inserted secondarily and when dilated helps to restore the vertebral height. Lastly, a cement mixture in then injected into the cavity created by dilating – filling the defect and once this mixture cures/hardens it stabilizes the anterior vertebral body.
The lumbar kyphoplasty procedure is reported with CPT code 22514 – Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; lumbar and +22515 for each additional thoracic or lumbar vertebral body. Please note the list of inclusive services for CPT code 22514.
For Vertebral Body Stenting (VBS), cement is still injected into the vertebral body but prior to that happening, the physician inserts a stent. Two types of stents we have seen in an ASC are the KIVA and SpineJack.
Kiva uses a PEEK material. It is instilled into the vertebral body over a guidewire to create a continuous loop which forms a cylindrical column. Picture a spring if you will. This is what the device will look like and as more PEEK material is instilled, the column lengthens to restore vertebral anatomy.
SpineJack is very similar to a scissor type car jack that you would use to change a tire. When the device is inserted and expanded the two flat jack plates on each end of the device would contact the bone and restore vertebral anatomy.
One of the so-called advantages of these devices is that there isn’t a loss of expansion when the stents are left in place. Some will say that when the balloon device is deflated you will lose some of the vertebral height that was gained during expansion.
The BIGGEST disadvantage comes from payor policies. While the AMA has stated that it would be appropriate to use the vertebral augmentation codes it warns that many carriers consider Vertebral Body Stenting to be experimental/investigational so instead of being able to submit a claim for this service the ASC will have to charge the patient and collect any fees from them.
In order to maintain compliance the ASC should confirm the patient’s policy with regards to reimbursement for a VBS procedure.