LCD Reference Article Billing and Coding Article

Billing and Coding: Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)

A56572

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A56572
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)
Article Type
Billing and Coding
Original Effective Date
12/01/2019
Revision Effective Date
01/10/2021
Revision Ending Date
N/A
Retirement Date
N/A

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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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CMS National Coverage Policy

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Article Guidance

Article Text

This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF).

Provisions in this article and the LCD only address Vertebral Augmentation for Osteoporotic Vertebral Compression Fracture (VCF). Coverage will remain available for medically necessary procedures for other conditions not included in this article/LCD.

Coding Guidelines

Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare.

For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.

All services/procedures performed on the same day for the same beneficiary by the physician/provider should be billed on the same claim.

Specific Coding Guidelines

No separate payment for venography performed during the operative session may be allowed and it should not be separately billed.

This LCD will not affect the use of this treatment for cancer related diagnoses. 

Exclusion for total number of levels involved will not apply for a diagnosis of multiple myeloma.

Documentation Requirements

The patient's medical record must contain documentation that fully supports the medical necessity for services included within the related LCD. (See "Indications and Limitations of Coverage.") This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

Response To Comments

Number Comment Response
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Coding Information

Bill Type Codes

Code Description

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Revenue Codes

Code Description

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(4 Codes)
Group 1 Paragraph

The correct use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in the related LCD.

Group 1 Codes
Code Description
M80.08XA Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture
M80.08XS Age-related osteoporosis with current pathological fracture, vertebra(e), sequela
M80.88XA Other osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture
M80.88XS Other osteoporosis with current pathological fracture, vertebra(e), sequela

Group 2

(8 Codes)
Group 2 Paragraph

Medicare is establishing the following limited coverage of 22510, 22511, 22512, 22513, 22514 and 22515 for Malignant Fractures.

Group 2 Codes
Code Description
C41.2* Malignant neoplasm of vertebral column
C79.51* Secondary malignant neoplasm of bone
C79.52* Secondary malignant neoplasm of bone marrow
C90.00* Multiple myeloma not having achieved remission
C90.01* Multiple myeloma in remission
C90.02* Multiple myeloma in relapse
M84.58XA Pathological fracture in neoplastic disease, other specified site, initial encounter for fracture
M84.58XS Pathological fracture in neoplastic disease, other specified site, sequela
Group 2 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Two diagnosis codes must be reported for Group 2. M84.58XA or M84.58XS must be reported in addition to one of the CXX.XX diagnosis codes listed.

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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

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Group 1 Codes

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Additional ICD-10 Information

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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 article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

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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 article, 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 article should be assumed to apply equally to all Revenue Codes.

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Code Description

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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
01/10/2021 R6

Revision Effective Date: 01/10/2021

Revised the Group 2 asterisk explanation for more clarification, stating "Two diagnosis codes must be reported for Group 2. M84.58XA or M84.58XS must be reported in addition to one of the CXX.XX diagnosis codes listed."

06/13/2024: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

01/10/2021 R5

Updated to indicate this article is an LCD Reference Article.

01/10/2021 R4

The LCD and Billing and Coding Article were returned for comment from May 28, 2020-July 13, 2020. Addition of C79.52* and C90.01* to Group II Codes. 

02/19/2020 R3

02/19/2020: Addition of Group 2 Paragraph: Medicare is establishing the following limited coverage of 22510, 22511, 22512, 22513, 22514 and 22515 for Malignant Fractures. Addition of Group 2 Codes: C90.02*; C90.00*; C41.2*; C79.51*; M84.58XA; M84.58XS. Addition of Group 2: Medical Necessity ICD-10 Codes Asterisk Explanation: *Must be reported with either M84.58XA or M84.58XS.

02/19/2020 R2

02/19/2020: This article was converted to the new Billing and Coding Article type per the draft to finalization. Bill types and Revenue codes have been removed from this article. Guidance on these codes is available in the Bill type and Revenue code sections.

 

02/19/2020 R1

02/19/2019: This article was converted to the new Billing and Coding Article type per the draft to finalization. Bill types and Revenue codes have been removed from this article. Guidance on these codes is available in the Bill type and Revenue code sections.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Public Versions
Updated On Effective Dates Status
06/04/2024 01/10/2021 - N/A Currently in Effect You are here
11/22/2023 01/10/2021 - N/A Superseded View
11/18/2020 01/10/2021 - N/A Superseded View
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