Wiki 20930,20936

[sdunaway1]

I have received several denials for the graft codes 20930,20936 when billed with spinal fusion code sets for BCID, MCR, MA , VA . I know that the Medicare payors set 20930 and 20936 as a zero rvu, although I have been taught by the AANS that we need to bill the graft codes as correct coding. How do you deal with the denials and edits you receive? Thank you for your assistance.

 

[amyjph]

If the codes are bundled or inclusive according to the health plan policy, you should not bill them on the claim. Some practices still want them "entered" into the system to track or for RVU purposes internally. If your practice does not do that, they should not be billed if you know they will be denied by the plan or rejected at the clearinghouse or by your internal system pre-bill. You're hitting an edit because it should not be on the claim. You're just creating too much extra work for no reason.

 

[ZubairHameed]

If you look into status indicator for both 20930 and 20936, they have status indicator B which as per CMS "The PFS always bundles payment for covered services into payment for other services not specified. No RVUs or payment amounts exist for these codes and Medicare never makes separate payment. When Medicare covers these services, we include payment for them in the payment for the services to which they’re incident. An example is a telephone call from a hospital nurse about the care of a patient.". So it is inclusive.