Vertebroplasty, Kyphoplasty & Sacroplasty

Vertebroplasty

Vertebroplasty is a procedure that replaces the vertebral body marrow with cement. It is performed through a percutaneous access.

(A bone needle is placed into the vertebral body from a transpedicular or lateral approach. Bone cement mixed with barium powder is then injected to fill the marrow of the abnormal vertebral body.)

This procedure is performed to treat painful fractured  vertebral bodies usually osteoporotic fractures.

Vertebroplasty is different from kyphoplasty - With kyphoplasty, a cavity is created in the vertebral body for subsequent placement of bone cement. 

Kyphoplasty

Kyphoplasty is a procedure that replaces the vertebral body marrow with cement. 

This is performed via percutaneous access followed by a balloon placement and inflation in the center of the vertebral body. 

A needle is placed into the vertebral body from a transpedicular or lateral approach. Contrast injection is performed to evaluate venous drainage Balloon placement and inflation is performed to create a cavity for cement and to regain the lost vertebral body height.

Arcuplasty uses a bone cutting wire through a side port on the needle to create a cavity for cement placement.

Sacroplasty 

When kyphoplasty, arcuplasty, or vertebroplasty is performed in the sacrum is called as Sacroplasty.

Procedure codes:

CPT 22510 -  Percutaneous vertebroplasty, 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance, cervicothoracic (bone biopsy included when performed).

CPT 22511 - Percutaneous vertebroplasty, 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance, lumbosacral (bone biopsy included when performed).

CPT 22512 - Percutaneous vertebroplasty, 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; each additional cervicothoracic or lumbosacral vertebral body (List separately in addition to code for primary procedure)  + Add on Code.

CPT 22513 - 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, thoracic

CPT 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

CPT 22515 - 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; each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure) + Add on Code.

Notes:

1. When vertebroplasty is performed on both thoracic and lumbar vertebrae, only one initial
level code must be reported for additional level use add on code, even though in a different section of
the spine. Eg. 22510, 22512

            

2. Do not use a -50 modifier when treating one vertebra

3. Do not report 20225, 22315, 22326, 22327 in conjunction with 22510, 22511, 22512, 22513, 22514, 22515, 0200T, 0201T, when performed at the same level)

4.  Vertebral augmentation is the process of cavity creation followed by the injection of the cement under image guidance. Sacral augmentation (sacroplasty) refers to the creation of a cavity within a sacral vertebral body followed by injection of cement to fill that cavity. use 0200T and 0201T.

Use code 0200T for unilateral sacroplasty with or without a balloon device, regardless of sites
treated unilaterally.

Use 0201T for bilateral sacroplasty, regardless of sites treated bilaterally.

5. Do not code deep bone biopsy at the same session and treatment as the vertebroplasty or kyphoplasty, as it is bundled services.

6. Biopsy at a completely separate bone site not treated with vertebroplasty or kyphoplasty would be separately billed.