ICD-10 Coding for Kyphoplasty(M80.08xA, C79.51)
Complete ICD-10-CM coding and documentation guide for Kyphoplasty. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Kyphoplasty
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M80.08xA | Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter | Use when kyphoplasty is performed due to osteoporotic vertebral compression fractures. |
|
| C79.51 | Secondary malignant neoplasm of bone | Use when kyphoplasty is performed due to vertebral fractures from metastatic cancer. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for kyphoplasty
Essential facts and insights about Kyphoplasty
Primary ICD-10-CM Codes for kyphoplasty
Decision Criteria
clinical Criteria
- Presence of osteoporotic vertebral compression fracture
Applicable To
- Osteoporotic vertebral compression fracture
Excludes
- Traumatic vertebral fracture
Clinical Validation Requirements
- Bone density T-score ≤-2.5
- Imaging evidence of vertebral compression fracture
Code-Specific Risks
- Incorrectly coding traumatic fractures as osteoporotic
Coding Notes
- Ensure documentation specifies osteoporosis as the cause of fracture.
C79.51 - Secondary malignant neoplasm of bone
Use when kyphoplasty is performed due to vertebral fractures from metastatic cancer.
Applicable To
- Metastatic bone disease
Excludes
- Primary bone cancer
Clinical Validation Requirements
- Biopsy confirmation of metastasis
- Imaging showing vertebral involvement
Coding Notes
Document the primary site of cancer if known.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Secondary malignant neoplasm of bone
C79.51Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Kyphoplasty to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M80.08xA.
Impact
Clinical: Leads to incorrect treatment assumptions., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials or reduced reimbursement.
Mitigation Strategy
Always document the underlying cause of the fracture.
Impact
Reimbursement: Incorrect coding can lead to denied claims or reduced reimbursement., Compliance: Non-compliance with CMS guidelines., Data Quality: Inaccurate medical records and billing data.
Mitigation Strategy
Use one primary code (22513 or 22514) and add-on code 22515 for additional levels.
Impact
Incorrectly billing separately for imaging guidance.
Mitigation Strategy
Ensure imaging guidance is included in kyphoplasty procedure codes.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Kyphoplasty, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Kyphoplasty
Use these documentation templates to ensure complete and accurate documentation for Kyphoplasty. These templates include all required elements for proper coding and billing.
Kyphoplasty for osteoporotic fracture
Specialty: OrthopedicsRequired Elements
- Patient demographics
- Diagnosis of osteoporosis
- Fracture details
- Procedure specifics
- Imaging guidance used
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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