Definitions of Vertebroplasty, Kyphoplasty and Sacroplasty CPT coding
Percutaneous Vertebroplasty: a minimally invasive procedure performed under fluoroscopic or computed tomography guidance. The cement that is injected into the vertebral body hardens immediately, reinforcing the collapsed vertebrae and providing immediate relief of pain.
Percutaneous Sacroplasty: this procedure, essentially identical, to the work done in the percutaneous vertebroplasty and entails guided injection of PMMA through a needle inserted into the fracture zone. It is most often described as a minimally invasive procedure employed as an alternative to conservative management (3-5) for sacral insufficiency fractures (SIF).
Vertebral Augmentation (Kyphoplasty): a minimally invasive procedure performed under
fluoroscopic or computed tomography guidance. This procedure restores height to the bone, reducing spinal deformity. Prior to the injection of the cement mixture, a bone tamp or expander is placed in the vertebra and expanded to lift up the fractured vertebra and create a void. The device is removed and then the vertebra is filled with the bone cement to restore the height, realign and stabilize the spine
Description of Vertebroplasty, Kyphoplasty and Sacroplasty CPT codes
Percutaneous vertebroplasty is a minimally invasive, image-guided procedure performed by a one- or two-sided injection of a vertebral body. A local anesthetic is administered. A needle is guided into the fractured vertebra under imaging guidance through a small puncture in the patient’s skin. Sterile biomaterial such as methyl methacrylate is injected from one or both sides into the damaged vertebral body and acts as a bone cement to reinforce the fractured or collapsed vertebra.
The procedure does not restore the original shape to the vertebra, but it does stabilize the bone, preventing further fracture or collapse. Following the procedure, the patient may experience significant, almost immediate pain relief. These codes include a vertebral bone biopsy, if performed, during the same operative session. Report 22510 for percutaneous vertebroplasty of one vertebral body at the cervicothoracic level; 22511 for percutaneous vertebroplasty of one vertebral body at the lumbosacral level; and 22512 for each additional cervicothoracic or lumbosacral vertebral body treated. All imaging guidance is included in these procedures.
22510 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance’ cervicothoracic
22511 lumbosacral
+ 22512 each additional cervicothoracic or lumbosacral vertebral body
Percutaneous Vertebral Augmentation
The physician performs a minimally invasive percutaneous kyphoplasty, a modification of the percutaneous vertebroplasty, to reduce the pain associated with osteoporotic vertebral compression fractures. This procedure has the added advantage of restoring vertebral body. The patient is placed in a prone, slightly flexed position. A 5 mm to 7 mm incision is made and small cannulae are inserted into the vertebral body from one or both sides.
Balloon catheters, called “tamps,” are inserted into the vertebra and inflated. Tamps create a void in the soft trabecular bone and restore vertebral alignment. Balloons are then deflated and high viscosity cement under direct image control is injected into the void previously created by bone tamps. Report 22513 when the procedure is performed in the thoracic spine; 22514 when the procedure is performed in the lumbar spine; and 22515 for each additional vertebral body. These codes include all imaging guidance performed.
22513 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy including when performed) using mechanical devices (e.g., kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging and guidance; thoracic
22514 lumbar
+ 22515 each additional thoracic or lumbar vertebral body
Percutaneous Sacroplasty
Percutaneous sacroplasty (sacral augmentation) is a minimally invasive, image-guided procedure performed by a one- or two-sided injection into a sacral insufficiency fracture. A local anesthetic is administered. The radiologist may use imaging techniques, such as CT scanning and fluoroscopy, to guide percutaneous placement of the needle during the procedure and to monitor the injection procedure.
Sterile biomaterial such as polymethyl methacrylate is injected from one or both sides into the sacrum and sacral insufficiency fracture and acts as bone cement to reinforce the fractured or collapsed vertebra. The procedure does not restore the original shape to the vertebra, but it does stabilize the bone, preventing further fracture or collapse. Report 0200T for unilateral percutaneous sacroplasty using one or more needles and 0201T for a bilateral procedure using two or more needles. These codes include the use of a balloon or mechanical device, imaging guidance, and bone biopsy, when utilized.
0200T Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when use, 1 or more needles, including imaging guidance and bone biopsy, when performed
0201T Percutaneous sacral augmentation (sacroplasty), bilateral injection(s), including the use of a balloon or mechanical device, when used, 1 or more needles, including imaging guidance and bone biopsy, when performed
Supply and Equipment coes used with 22510 and 22511
SA039 kit, vertebroplasty (LP2, CDO)
SA046 pack, drapes, laparotomy (chest-abdomen)
SA048 pack, minimum multi-specialty visit
SB001 cap, surgical
SB008 drape, sterile, c-arm, fluoro
SB012 drape, sterile, for Mayo stand
SB024 gloves, sterile
SB028 gown, surgical, sterile
SB034 mask, surgical, with face shield
SC028 needle, 18-26g 1.5-3.5in, spinal
SC029 needle, 18-27g
SF033 scalpel with blade, surgical (#10-20)
SG056 gauze, sterile 4in x 4in (10 pack uou)
SG074 steri-strip (6 strip uou)
SH015 barium sulfate, sterile (Biotrace) (6gm uou)
SH020 bone cement (full dose pack uou) (Osteobond, Simplex)
SH047 lidocaine 1%-2% inj (Xylocaine)
SJ017 DuraPrep surgical soln (26ml uou)
SK075 skin marking pen, sterile (Skin Skribe)
EF031 table, power
EL014 room, radiographic-fluoroscopic
EQ011 ECG, 3-channel (with SpO2, NIBP, temp, resp)
EQ032 IV infusion pump
EQ138 instrument pack, medium ($1500 and up)
EQ168 light, exam
ED050 Technologist PACS workstation
ED053 Professional PACS Workstation
EF018 stretcher
EF027 table, instrument, mobile
Supple and equipment codes used with 22513 and 22514
SA046 pack, drapes, laparotomy (chest-abdomen)
SA048 pack, minimum multi-specialty visit
SA054 pack, post-op incision care (suture)
SA111 Kyphoplasty kit, first fracture
SB001 cap, surgical
SB008 drape, sterile, c-arm, fluoro
SB012 drape, sterile, for Mayo stand
SB024 gloves, sterile
SB028 gown, surgical, sterile
SB034 mask, surgical, with face shield
SC028 needle, 18-26g 1.5-3.5in, spinal
SC029 needle, 18-27g
SF033 scalpel with blade, surgical (#10-20)
SF055 Bone biopsy device
SG056 gauze, sterile 4in x 4in (10 pack uou)
SG074 steri-strip (6 strip uou)
SH047 lidocaine 1%-2% inj (Xylocaine)
SH100 Bone cement with mixer
SJ017 DuraPrep surgical soln (26ml uou)
SK075 skin marking pen, sterile (Skin Skribe)
ED050 Technologist PACS workstation
ED053 Professional PACS Workstation
EF018 stretcher
EF027 table, instrument, mobile
EF031 table, power
EL014 room, radiographic-fluoroscopic
EQ011 ECG, 3-channel (with SpO2, NIBP, temp, resp)
EQ032 IV infusion pump
EQ138 instrument pack, medium ($1500 and up)
Coding tips
Vertebroplasty and vertebral augmentation procedures include bone biopsy when performed, moderate sedation, and the image guidance necessary for this procedure.
One primary procedure code is reported with an add-on code for each additional level to which the procedure was performed.
The sacrum and sacral procedures are reported only once per encounter
The CPT codes for Percutaneous Vertebroplasty, Percutaneous Vertebral Augmentation, and Sacroplasty procedures are assigned to one of the following APC’s:
5113, Level 3 Musculoskeletal Procedures, include code(s) 22510, 22511 and 22512
5114, Level 4 Musculoskeletal Procedures, include code(s) 22513, 22514, 22515, 0200T and 0201T