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Wiki 22630/63047 and 63081/22551

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J

jmirchin@stamhealth.org

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Chappaqua, New York
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Hi all,

1st question- One of my surgeons is trying to bill both procedures for the same segments/interspaces. According to NCCI edits you cannot bill these together at the same interspace.

2nd question- Same surgeon billing 63081 and 22551 for same segments. There is a CCI edit here as well.

Does anyone have any resources or references they can direct me to?

Please let me know.

Thanks so much!
 
For 22630/63047

CHAPTER IV
SURGERY: MUSCULOSKELETAL SYSTEM

&

CHAPTER VIII
SURGERY: ENDOCRINE, NERVOUS, EYE AND OCULAR ADNEXA

25. CMS payment policy does not allow separate payment for CPT codes 63042 (laminotomy...; lumbar) or 63047 (laminectomy...; lumbar) with CPT codes 22630 or 22633 (arthrodesis; lumbar) when performed at the same interspace. If the two procedures are performed at different interspaces, the two codes of an edit pair may be reported with modifier 59 appended to CPT code 63042 or 63047.
 
For 63081/22551, the AANS and KZA have good info on this
63081 includes any disk work above and below. You cant be paid on "double" the disk work for 22551. You would have to use 22554/22585 for any arthrodesis done at the levels effected by the corpectomy.
 
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