You can report the professional component for your surgeon’s services.
In case your surgeon carries out vertebroplasties, a review of how to report radiological assistance your surgeon utilized will help you master the applicable CPT® codes and these claims.
Know When to Append Modifier 26
When carrying out a percutaneous vertebroplasty, your surgeon will use imaging in order to position the needle or to evaluate the injection technique. You report the radiological supervision with CPT® codes 72291 (Radiological supervision and interpretation, percutaneous vertebroplasty, vertebral augmentation, or sacral augmentation [sacroplasty], including cavity creation, per vertebral body or sacrum; under fluoroscopic guidance) or 72292 (Radiological supervision and interpretation, percutaneous vertebroplasty, vertebral augmentation, or sacral augmentation [sacroplasty], including cavity creation, per vertebral body or sacrum; under CT guidance) depending upon whether your surgeon uses computed tomography (CT) in place of fluoroscopic guidance.
You append modifier 26 (Professional component) if the procedure is carried out in a facility setting. This has been historically distinctly reportable to account for conditions in which the imaging interpretation is carried out by a separate physician, usually a radiologist, from the physician carrying out the vertebroplasty. As per the trends in CPT®, the services may become bundled in case a significant majority of both services are carried out by the same physician.
Caveat: In case you append modifier 26, you should save a hard copy of the image(s), and you should dictate a distinct procedural report, and sign it (or electronically sign it) separately.
Coding example: In case your surgeon carries out vertebroplasty at T12 and L1 and uses fluoroscopic guidance, you report CPT® codes 22520 (Percutaneous vertebroplasty [bone biopsy included when performed], 1 vertebral body, unilateral or bilateral injection; thoracic), 72291-26 and +22522 (Percutaneous vertebroplasty [bone biopsy included when performed], 1 vertebral body, unilateral or bilateral injection; each additional thoracic or lumbar vertebral body [List separately in addition to code for primary procedure]).
Modifier 26 would be added for the provider’s claim if the provider owned the fluoroscopy equipment. If the equipment is physician owned, the full work value would be reported. CPT® codes 72291 and 72292 both carry a PT/TC indicator of "1", signifying that the procedures have both a technical and professional component.
In case your payer is Medicare, look out the edit for radiological supervision services. CPT® codes 72291 and 72292 are to be reported per segment. Medicare has an unlikely edit of "3" that is used for the radiological supervision services -- keep an eye out for this constraint for your Medicare carriers.
