Saturday, March 18, 2017

Vertebral augmentation procedures VAPs 22514, 22510

CPT/HCPCS Codes

Group 1 Codes:

22510 Perq cervicothoracic inject
22511 Perq lumbosacral injection
22512 Vertebroplasty addl inject
22513 Perq vertebral augmentation
22514 Perq vertebral augmentation
22515 Perq vertebral augmentation
0200T Perq sacral augmt unilat inj
0201T Perq sacral augmt bilat inj

Coverage Indications, Limitations, and/or Medical Necessity

Indications

The performance of Vertebral Augmentation Procedures (VAPs) are considered to be medically reasonable and necessary when utilized in the treatment of the following conditions:

Persistent debilitating pain caused by the recent (e.g. 8 – 12 weeks) pathologic fracture or collapse of noncervical vertebrae.

Initially, conservative management should be implemented prior to performing a VAP. Conservative management includes, but is not limited to, immobilization, analgesia, physical therapy, etc.
Exceptions to conservative management may include a high level of pain, disability and neurologic compromise.

Painful non-unions of Vertebral Compression Fractures (VCF);

Back pain associated with osteolytic metastatic disease involving a vertebral body;

Back pain associated with multiple myeloma involving a vertebral body; or

Painful hemangiomas.


Limitations

Coverage for only one procedure per lifetime per vertebra will be allowed. If a repeat procedure on a single vertebra is to be performed, medical record documentation must support the medical necessity of the repeat procedure.

Medicare will not provide coverage for procedures performed for asymptomatic VCFs, VCFs responding appropriately to conservative therapy, or for healed VCFs.

Bone biopsy is considered integral to the procedures and not separately billable.

Treatment of kyphosis in the absence of a painful VCF is not covered.

VAPs is contraindicated in osteomyelitis / discitis involving the vertebral column.



Bill Type Codes:

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
999x Not Applicable

Revenue Codes:
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the policy, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

99999 Not Applicable


ICD-10 Codes that Support Medical Necessity


ICD-10 CODE DESCRIPTION

C41.2 Malignant neoplasm of vertebral column
C79.51 - C79.52 - Opens in a new window Secondary malignant neoplasm of bone - Secondary malignant neoplasm of bone marrow
C90.00 - C90.02 - Opens in a new window Multiple myeloma not having achieved remission - Multiple myeloma in relapse
D18.09 Hemangioma of other sites
D47.Z9 Other specified neoplasms of uncertain behavior of lymphoid, hematopoietic and related tissue
D48.0 Neoplasm of uncertain behavior of bone and articular cartilage
D49.2 Neoplasm of unspecified behavior of bone, soft tissue, and skin
M48.54XA Collapsed vertebra, not elsewhere classified, thoracic region, initial encounter for fracture
M48.55XA Collapsed vertebra, not elsewhere classified, thoracolumbar region, initial encounter for fracture
M48.56XA Collapsed vertebra, not elsewhere classified, lumbar region, initial encounter for fracture
M48.57XA Collapsed vertebra, not elsewhere classified, lumbosacral region, initial encounter for fracture
M48.58XA Collapsed vertebra, not elsewhere classified, sacral and sacrococcygeal region, initial encounter for fracture
M80.08XA Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture
M80.88XA Other osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture
M84.58XA Pathological fracture in neoplastic disease, other specified site, initial encounter for fracture
M84.68XA Pathological fracture in other disease, other site, initial encounter for fracture
S22.010A Wedge compression fracture of first thoracic vertebra, initial encounter for closed fracture
S22.011A Stable burst fracture of first thoracic vertebra, initial encounter for closed fracture
S22.018A Other fracture of first thoracic vertebra, initial encounter for closed fracture
S22.019A Unspecified fracture of first thoracic vertebra, initial encounter for closed fracture
S22.020A Wedge compression fracture of second thoracic vertebra, initial encounter for closed fracture
S22.021A Stable burst fracture of second thoracic vertebra, initial encounter for closed fracture
S22.028A Other fracture of second thoracic vertebra, initial encounter for closed fracture
S22.029A Unspecified fracture of second thoracic vertebra, initial encounter for closed fracture
S22.030A Wedge compression fracture of third thoracic vertebra, initial encounter for closed fracture
S22.031A Stable burst fracture of third thoracic vertebra, initial encounter for closed fracture
S22.038A Other fracture of third thoracic vertebra, initial encounter for closed fracture
S22.039A Unspecified fracture of third thoracic vertebra, initial encounter for closed fracture
S22.040A Wedge compression fracture of fourth thoracic vertebra, initial encounter for closed fracture
S22.041A Stable burst fracture of fourth thoracic vertebra, initial encounter for closed fracture
S22.048A Other fracture of fourth thoracic vertebra, initial encounter for closed fracture
S22.049A Unspecified fracture of fourth thoracic vertebra, initial encounter for closed fracture
S22.050A Wedge compression fracture of T5-T6 vertebra, initial encounter for closed fracture
S22.051A Stable burst fracture of T5-T6 vertebra, initial encounter for closed fracture
S22.058A Other fracture of T5-T6 vertebra, initial encounter for closed fracture
S22.059A Unspecified fracture of T5-T6 vertebra, initial encounter for closed fracture
S22.060A Wedge compression fracture of T7-T8 vertebra, initial encounter for closed fracture
S22.061A Stable burst fracture of T7-T8 vertebra, initial encounter for closed fracture
S22.068A Other fracture of T7-T8 thoracic vertebra, initial encounter for closed fracture
S22.069A Unspecified fracture of T7-T8 vertebra, initial encounter for closed fracture
S22.070A Wedge compression fracture of T9-T10 vertebra, initial encounter for closed fracture
S22.071A Stable burst fracture of T9-T10 vertebra, initial encounter for closed fracture
S22.078A Other fracture of T9-T10 vertebra, initial encounter for closed fracture
S22.079A Unspecified fracture of T9-T10 vertebra, initial encounter for closed fracture
S22.080A Wedge compression fracture of T11-T12 vertebra, initial encounter for closed fracture
S22.081A Stable burst fracture of T11-T12 vertebra, initial encounter for closed fracture
S22.088A Other fracture of T11-T12 vertebra, initial encounter for closed fracture
S22.089A Unspecified fracture of T11-T12 vertebra, initial encounter for closed fracture
S32.010A Wedge compression fracture of first lumbar vertebra, initial encounter for closed fracture
S32.011A Stable burst fracture of first lumbar vertebra, initial encounter for closed fracture
S32.018A Other fracture of first lumbar vertebra, initial encounter for closed fracture
S32.019A Unspecified fracture of first lumbar vertebra, initial encounter for closed fracture
S32.020A Wedge compression fracture of second lumbar vertebra, initial encounter for closed fracture
S32.021A Stable burst fracture of second lumbar vertebra, initial encounter for closed fracture
S32.028A Other fracture of second lumbar vertebra, initial encounter for closed fracture
S32.029A Unspecified fracture of second lumbar vertebra, initial encounter for closed fracture
S32.030A Wedge compression fracture of third lumbar vertebra, initial encounter for closed fracture
S32.031A Stable burst fracture of third lumbar vertebra, initial encounter for closed fracture
S32.038A Other fracture of third lumbar vertebra, initial encounter for closed fracture
S32.039A Unspecified fracture of third lumbar vertebra, initial encounter for closed fracture
S32.040A Wedge compression fracture of fourth lumbar vertebra, initial encounter for closed fracture
S32.041A Stable burst fracture of fourth lumbar vertebra, initial encounter for closed fracture
S32.048A Other fracture of fourth lumbar vertebra, initial encounter for closed fracture
S32.049A Unspecified fracture of fourth lumbar vertebra, initial encounter for closed fracture
S32.050A Wedge compression fracture of fifth lumbar vertebra, initial encounter for closed fracture
S32.051A Stable burst fracture of fifth lumbar vertebra, initial encounter for closed fracture
S32.058A Other fracture of fifth lumbar vertebra, initial encounter for closed fracture
S32.059A Unspecified fracture of fifth lumbar vertebra, initial encounter for closed fracture
S32.110A Nondisplaced Zone I fracture of sacrum, initial encounter for closed fracture
S32.111A Minimally displaced Zone I fracture of sacrum, initial encounter for closed fracture
S32.119A Unspecified Zone I fracture of sacrum, initial encounter for closed fracture
S32.120A Nondisplaced Zone II fracture of sacrum, initial encounter for closed fracture
S32.121A Minimally displaced Zone II fracture of sacrum, initial encounter for closed fracture
S32.129A Unspecified Zone II fracture of sacrum, initial encounter for closed fracture
S32.130A Nondisplaced Zone III fracture of sacrum, initial encounter for closed fracture
S32.131A Minimally displaced Zone III fracture of sacrum, initial encounter for closed fracture
S32.139A Unspecified Zone III fracture of sacrum, initial encounter for closed fracture
S32.14XA Type 1 fracture of sacrum, initial encounter for closed fracture
S32.15XA Type 2 fracture of sacrum, initial encounter for closed fracture
S32.16XA Type 3 fracture of sacrum, initial encounter for closed fracture
S32.17XA Type 4 fracture of sacrum, initial encounter for closed fracture
S32.19XA Other fracture of sacrum, initial encounter for closed fracture

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