22633/22630 with 63047 Arthrodesis Interbody technique with Decompression same level

g&s18HI*

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Wondering how others are billing the same level with interbody fusion 22633/22630 with decompression 63047 for example. My providers are completing the interbody technique and also completing a wide complete laminectomy with foraminotomy and decompressing the exiting and sometimes traversing nerve root(s). This to me is more than than a typical laminectomy to prepare the interspace. NASS examples show these codes billed together and their reference book states, "When a more aggressive decompression of neural elements is needed (beyond the typical decompression of neural elements inherent in removing bone to access the interbody space for the interbody fusion), it is appropriate to code for such decompression 63047." It further states, "It's recommended the specific nerve root(s) decompressed be documented (example: L4, L5 nerve roots were decompressed via laminectomies with foraminotomies), which my providers are doing and stating. There is however an NCCI edit with Medicare and modifier 59 is also needed. Help is appreciated on how others are billing. Keeping in mind CPT code 22630/22633 both say, "other than for decompression.":D
 

CoderinJax

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Great question

I would also like to know the answer to this. What exactly would the records need to show in order to allow the 63047 to be billed with the 22630/22633 codes? Any Ortho coder's out there know the answer to the above question?:confused:


(Also, ZDX0764, you may want to post this same question in the Ortho section)
 
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amexnikki23

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Did you ever solve this problem?

I would also like to know the answer to this. What exactly would the records need to show in order to allow the 63047 to be billed with the 22630/22633 codes? Any Ortho coder's out there know the answer to the above question?:confused:


(Also, ZDX0764, you may want to post this same question in the Ortho section)

Hi, I was wondering if you have figured this one out since this is no answer on here. :)
 

amyjph

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https://www.karenzupko.com/cms-denials-for-cpt-code-22633-and-63047/

CMS Denials for CPT code 22633 and 63047
By The Coding Coach / In Coding Coach, Orthopaedics

February 26, 2015
Question:
We reported CPT code 63047 with 22633 for a laminectomy, facetectomy, foraminotomy at the same level to Medicare. Both service were performed at L4-5 and well documented according to the CPT rules. We received a denial for CPT code 63047 as inclusive and have tried to appeal, but Medicare will not reverse the denial.
Answer:
Medicare, via the National Correct Coding Initiative (NCCI) edits, communicated that this code combination, when reported together for work at the same level during the same operative session by the same surgeon, will consider the services inclusive and will not allow payment for both services. Medicare considers the work of the laminectomy and decompression to overlap with the work that is valued into the interbody fusion. While CPT states the two are reportable when the work is over and beyond the work of the discectomy, CMS does not consider the work at the same level overlapping. Moving forward, do not report the 63047 with 22630 or 22633 to Medicare unless the work associated with the laminectomy as defined by CPT code 63047 is performed at a level independent of the interbody fusion (22630 and 22633).
 
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