Wiki Medicare denied kyphoplasty

[such78]

I code for acute hospital. Recently, I got flagged for kyphoplasty denied from Medicare.

Surgeon performed T11 kyphoplasty with intraoperative fluoroscopy.

1. I assigned diagnoses as M80.88XA (documentation is supported the ICD-10-CM). It is in LCD group 1 listed diagnoses.
2. Fluoroscopy is not charged because the imaging is bundled.
3. No modifier is assigned.

How should I clear the flag for this case?


Thank you for the advice.

 

[lexvcarter]

https://www.cms.gov/medicare-coverage-database/details/technology-assessments-details.aspx?TAId=25&bc=AAAQAAAAAAAAAA%253D%253D&

 

[such78]

https://www.cms.gov/medicare-coverage-database/details/technology-assessments-details.aspx?TAId=25&bc=AAAQAAAAAAAAAA%253D%253D&

My dx is in the LCD list, someone suggested me to use the modifier to indicate the ABN for this procedure.

 

[fwnewbie]

Is this age-related or a chemically induced osteoporosis? If it's age-related you are looking for a different dx code. If due to side-effect, you need to show and adverse affect code as per M80. section instructions. Not sure if this is the problem cuz I'm too new at this know, but I like to research questions like this to continue learning.

 

[such78]

Is this age-related or a chemically induced osteoporosis? If it's age-related you are looking for a different dx code. If due to side-effect, you need to show and adverse affect code as per M80. section instructions. Not sure if this is the problem cuz I'm too new at this know, but I like to research questions like this to continue l

I think you have to check with your local LCD codable dx for this surgeries with doctor documentation. It was used to have a long list of reportable diagnoses, but they limit reportable diagnoses.