Part B Insider (Multispecialty) Coding Alert

Published on Sat Aug 05, 2006 PDF

CCI edit revocation is retroactive to April

Spine surgeons showed some backbone--and the results will add about $1,500 per surgery to your bottom line.

In response to complaints, the Correct Coding Initiative has agreed to remove a controversial edit that bundled two spine surgery codes together. Effective last April, the edit made 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace [other than for decompression], single interspace; lumbar) a component of 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar [with or without lateral transverse technique]) (See PBI, Vol. 7, No. 22).

Not only will CCI delete the edit starting October 1, but the change will be retroactive--so you can resubmit any claims that were denied since April 1.

Get your denials ready for the Oct. resubmission date: Because the edit deletion will be retroactive to April 1, you can resubmit your claims after Oct. 1 if your carrier denied any claims based on the edit. Include a letter explaining why you-re resubmitting the claim seeking reimbursement for the interbody fusion.

This is very big news for spine surgery practices, says Annette Grady, a coding consultant and an officer on the AAPC National Advisory Board. Spine surgeons and their associations mounted a campaign against the edit, saying the procedures were totally separate. A posterior lumbar interbody fusion (22630) fuses the anterior and middle columns of the spine, while 22612 covers the posterior lateral region.

-It's important for offices to gather documentation prior to the October 1 change so as to secure retroactive reimbursement,- urges Matthew Twetten, senior manager of Reimbursement and Health Policy at the North American Spine Society.

St. John's Health System in Tulsa, OK is already reviewing claims to see if there are any previous denials that need to be appealed, reports coder Katherine Phelan. Changes to CCI edits -always cause me to dig deeper and check for accuracy and documentation to substantiate anything we are billing.-

Note: If your surgeon performed both procedures together and you only billed 22612 because you knew the payer would deny 22630, you can still resubmit your claim--even though you don't have a denial letter. You should send the payer a copy of the surgeon's operative report, along with a letter stating that you collected for 22612 but that you-re now requesting payment for the interbody fusion, which you originally didn't bill due to the previous edit.

Looking ahead: Once the CCI formalizes the edit deletion on Oct. 1, you will not need to append any modifiers to your claim if you bill 22630 and 22612 together--unless your payor requires you to attach modifier 51 (Multiple procedures) to subsequent line items. If that is the case, you will report 22612 followed by 22630-51, because 22612 is the higher-paying service.