VERTEBRAL COMPRESSION FRACTURE - Merit Medical
[Pages:2]VERTEBRAL COMPRESSION FRACTURE
Coding and Reimbursement Information 2021
Hospital Outpatient, Ambulatory Surgery Center and Physician Office
(Calendar Year Jan 1, 2021 ? Dec 31, 2021)
CPT Copyright 2020 American Medical Association. All rights reserved. CPT? is a registered trademark of the American Medical Association.
CPT Code
Description
APC
Status Indicator
Percutaneous vertebroplasty (bone biopsy
22510
included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of
5113
J1
all imaging guidance; cervicothoracic
Percutaneous vertebroplasty (bone biopsy
22511
included when performed), 1 vertebral body, unilateral or bilateral injection, inclu-
5113
J1
sive of all imaging guidance; lumbosacral
Percutaneous vertebroplasty (bone biopsy
included when performed), 1 vertebral body,
unilateral or bilateral injection, inclusive of
22512 all imaging guidance; each additional
-
N
cervicothoracic or lumbosacral vertebral
body (List separately in addition to code for
primary procedure)
Percutaneous vertebral augmentation,
including cavity creation (fracture reduction
and bone biopsy included when performed)
22513 using mechanical device (eg, kyphoplasty),
5114
J1
1 vertebral body, unilateral or bilateral can-
nulation, inclusive of all imaging guidance;
thoracic
Percutaneous vertebral augmentation,
including cavity creation (fracture reduction
and bone biopsy included when performed)
22514 using mechanical device (eg, kyphoplasty),
5114
J1
1 vertebral body, unilateral or bilateral
cannulation, inclusive of all imaging
guidance; lumbar
Percutaneous vertebral augmentation,
including cavity creation (fracture reduction
and bone biopsy included when performed)
using mechanical device (eg, kyphoplasty),
22515 1 vertebral body, unilateral or bilateral
-
N
cannulation, inclusive of all imaging
guidance; each additional thoracic or
lumbar vertebral body (List separately in
addition to code for primary procedure)
Hospital Outpatient 1
NATIONAL BASE PAYMENT
Ambulatory Surgery Center 2
Physician Services Fee 3
Performed in Office
Performed in Hospital or
ASC
$2,830.40
$1,335.09
$1,967.62 $438.96
$2,830.40
$1,335.09
$1,960.99 $412.79
Packaged
Packaged
$852.79
$210.41
$6,264.95
$2,944.24
$6,815.32 $523.05
$6,264.95
$2,944.24
$6,789.85 $488.50
Packaged
Packaged
$3,661.68 $224.01
APC=Ambulatory Payment Classification. Status Indicator J1 is a comprehensive APC. All associated services are packaged within the primary code with J1 status indicator. Status Indicator N payment is packaged into payment for other services. There is no separate APC payment. Physician payment is not impacted by APC payment or status indicators.
Physician Payment included in-office procedure payment NOTE: Do not report 22510-22512 in conjunction with 20225, 22310, 22315, 22325, 22327 when performed at same level as 22510-22512. Do not report 22513-22515 in conjunction with 20225, 22310, 22315, 22325, 22327 when performed at same level as 22513-22515.
1. CY 2021 Medicare Hospital Outpatient Prospective Payment System Final Rule; (Federal Register, Vol. 85, No. 249, CMS-1736-FC, 1736-IFC, 2/29/2020) OPPS Addendum B, effective January 1, 2021.
2. CY 2021 Medicare Ambulatory Surgical Center Payment System Final Rule; (Federal Register, Vol. 85, No. 249, CMS-1736-FC, 1736-IFC, 12/29/2020) ASC Addendum AA, effective January 1, 2021.
3. CY 2021 Medicare Physician Fee Schedule Final Rule; (Federal Register, Vol. 85, No. 248, CMS-1734-F) RVU21A.
CONTINUED
VERTEBRAL COMPRESSION FRACTURE
Coding and Reimbursement Information 2021
Hospital Inpatient
(Fiscal Year Oct 1, 2020 ? Sept 30, 2021)
ICD-10-PCS Procedure Code4
Description
0PU33JZ
Supplement Cervical Vertebra with Synthetic Substitute, Percutaneous Approach
MS-DRG
MS-DRG 515 Other musculoskeletal system & connective tissue O.R. procedures with MCC
Estimated Base Payment5
$24,850.50
0PU43JZ
Supplement Thoracic Vertebra with Synthetic Substitute, Percutaneous Approach
MS-DRG 516 Other musculoskeletal system & connective
tissue O.R. procedures with CC
$15,535.32
0QU03JZ
Supplement Lumbar Vertebra with Synthetic Substitute, Percutaneous Approach
MS-DRG 517 Other musculoskeletal system & connective tissue O.R.
procedures without CC/MCC
$11,064.29
Copyright 2020 American Medical Association.
Documentation must justify MS-DRG used
4. CMS FY 2021 ICD-10-PCS MS-DRG Definitions Manual. ICD-10 codes and descriptions are copyright 2020 World Health Organization; revised for use in the United States by the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS) as ICD-10-CM / ICD-10-PCS.
5. Fiscal Year (FY) 2021 Medicare Hospital Inpatient Final Rule And Correction Notice Tables 1A-5. CMS 1735F Federal Register / Vol. 85, No. 182 / Friday, September 18, 2020 / Rules and Regulations MS-DRG payment updating for operating and capital payments, provision for labor and quality data submission less IME and DSH for a community hospital. Specific MS-DRG payment varies significantly across hospitals.
Place of Service Code Set 6 Listed below are place of service codes and descriptions. These codes should be used on professional claims to specify the entity where service(s) were rendered. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes.
Place of Service Code(s) Place of Service Name
Place of Service Description
Location, other than a hospital, skilled nursing facility (SNF), military treatment facility,
11
Office
community health center, State or local public health clinic, or intermediate care facility (ICF), where the health professional routinely provides health examinations, diagnosis, and
treatment of illness or injury on an ambulatory basis.
A facility, other than psychiatric, which primarily provides diagnostic, therapeutic (both sur-
21
Inpatient Hospital
gical and nonsurgical), and rehabilitation services by, or under, the supervision of physicians
to patients admitted for a variety of medical conditions.
22
On Campus-Outpatient Hospital
A portion of a hospital's main campus which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization. (Description change effective January1, 2016)
24
Ambulatory Surgical Center
A freestanding facility, other than a physician's office, where surgical and diagnostic services are provided on an ambulatory basis.
6.
Merit Medical Systems, Inc. gathers reimbursement information from third-party sources such as Medicare and presents this information for illustrative purposes only. Merit Medical Systems, Inc. cannot guarantee coverage or payment for products or procedures. Actual payment to providers will vary based on many factors including but not limited to geographic location, setting of care, & hospital facility status (e.g., teaching, non-teaching). Under the MS-DRG system, procedures may be assigned to a number of other MS-DRGs and actual payment to providers may not be limited to the MS-DRGs shown above. Providers should report the codes that most accurately describe the patients' medical condition, procedures performed, & the products used. Use of the service & the product must comply with Medicare coverage guidelines in being reasonable & necessary for the care of the patient to support reimbursement. Prior to claims submission, it is the providers' responsibility to confirm appropriate coding for procedures or combination of procedures with specific payers, such as Medicare, and/or coding authorities, such as the American Medical Association and medical societies. Coverage and payment policies also change over time and Merit Medical Systems, Inc. assumes no obligation to update the information provided herein.
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