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Percutaneous vertebral augmentation is a minimally invasive procedure designed to treat compression fractures of the vertebrae, which can occur due to various conditions such as osteoporosis, multiple myeloma, primary or metastatic malignant lesions, benign lesions, or traumatic injuries to the spine. This procedure is particularly beneficial for patients suffering from debilitating pain and instability caused by these fractures. During the procedure, the patient is typically positioned in a prone manner, allowing the physician to access the affected vertebra effectively. The use of fluoroscopic guidance is essential, as it provides real-time imaging to ensure accurate placement of instruments and materials. A small incision is made over the targeted vertebra, and a working channel is created by advancing a needle to the appropriate location within the vertebra. This channel allows for the potential collection of biopsy samples if necessary. Following this, a guidewire is introduced, and a cannula is placed over it to facilitate the introduction of a mechanical device, which is used to create a cavity within the vertebra. This cavity is then filled with bone graft material or polymethylmethacrylate (PMMA) bone cement, which is mixed with contrast medium to allow for visual confirmation of the filling process. The procedure can be performed unilaterally or bilaterally, depending on the specific needs of the patient and the extent of the fracture. The CPT® code 22523 specifically refers to the augmentation of a single thoracic vertebra, with additional codes available for lumbar vertebrae and for multiple vertebrae as needed.
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Compression Fractures Percutaneous vertebral augmentation is indicated for the treatment of compression fractures resulting from osteoporosis, multiple myeloma, primary or metastatic malignant lesions, benign lesions, or traumatic injuries to the spine.
Step 1: Patient Positioning The patient is positioned in a prone manner to provide optimal access to the affected thoracic vertebra. This positioning is crucial for the subsequent steps of the procedure.
Step 2: Incision and Access A small skin incision is made over the targeted vertebra. This incision allows for the introduction of instruments necessary for the procedure. Fluoroscopic guidance is utilized to ensure precise targeting of the affected area.
Step 3: Cavity Creation A needle is advanced to the desired location within the vertebra to create a working channel. This channel facilitates access for further instrumentation and may also allow for needle biopsies to be obtained if indicated.
Step 4: Guidewire Placement A guidewire is then advanced through the needle into the vertebra. Once the guidewire is in place, the needle is withdrawn, and a cannula is advanced over the guidewire to maintain access to the vertebra.
Step 5: Mechanical Device Insertion The guidewire is removed, and the procedure is repeated on the opposite side of the vertebra. A mechanical device, such as a miniature expandable jack or balloon tamp, is then inserted through the cannula. This device is expanded to create a cavity within the vertebra while contrast medium is instilled simultaneously to visualize the cavity formation.
Step 6: Fracture Reduction The mechanical device may also be utilized to reduce the fracture during this step, ensuring proper alignment and stabilization of the vertebra.
Step 7: Filling the Cavity Once the cavity is created, the mechanical device is removed. The cavity is then filled with morselized bone graft material, polymethylmethacrylate (PMMA) bone cement, or another bone graft substitute. A bone biopsy needle is used for this purpose, and the graft or cement is mixed with contrast medium to allow the physician to observe the filling process.
Step 8: Finalizing the Procedure After the cavity is filled, the needle is withdrawn. A second injection of the graft material or cement is performed on the opposite side of the vertebral body to ensure comprehensive treatment of the fracture.
Post-procedure care typically involves monitoring the patient for any immediate complications and assessing pain levels. Patients may be advised on activity restrictions and rehabilitation protocols to support recovery. Follow-up imaging may be necessary to evaluate the success of the augmentation and to ensure proper healing of the vertebra.
| Short Descr | PERCUT KYPHOPLASTY THOR | Medium Descr | PERCUTANEOUS VERTEBRAL AUGMENTATION THORACIC | Long Descr | Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, 1 vertebral body, unilateral or bilateral cannulation (eg, kyphoplasty); thoracic | Status Code | Active Code | Global Days | 010 - Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 9 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P3D - Major procedure, orthopedic - other | MUE | Not applicable/unspecified. | CCS Clinical Classification | 148 - Other fracture and dislocation procedure |
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