22845 with 22853

kellz0913

Networker
Messages
25
Location
Bensenville, IL
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0
Hi - was wondering how anyone is getting paid on the CPT code 22845 when billed with 22853. The doctor documents that the anterior instrumentation was unrelated to anchoring the cage but they are still denying it. We've tried sending in the OP Report and letters... etc. Has anyone sent anything in to the insurance company that actually works?
 

MZoltek3

Contributor
Messages
14
Location
Mt. Laurel, NJ
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I usually have to appeal these with op notes, letter and I send images from the product if I have it so that they can see that they do not include their own anchoring system. I recite the verbiage from AMA CPT book. Sometimes they pay, sometimes they do not. This is a hard fight appeal.
 

kellz0913

Networker
Messages
25
Location
Bensenville, IL
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0
I usually have to appeal these with op notes, letter and I send images from the product if I have it so that they can see that they do not include their own anchoring system. I recite the verbiage from AMA CPT book. Sometimes they pay, sometimes they do not. This is a hard fight appeal.
Thanks so much! Is there a certain letter that you send in?
 

MZoltek3

Contributor
Messages
14
Location
Mt. Laurel, NJ
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0
No, I just draft a general letter with the product names and something like this: According to CPT 22846 (or whatever one you used) may be reported for separate use of the instrumentation/plate when the interbody device does not include its own anchoring system. Depends which code they deny... plate or spacer.
 

mandyh

New
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5
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We have the same issue! My doctor dictates the anterior instrumentation is completely separate from the cages in the operative report now and I underline it in that report. I also bill 22845-59. I was told by BCBS they will always deny 22845-59 and then I have to appeal and it always takes so long to get payment! several appeals later.
 

kellz0913

Networker
Messages
25
Location
Bensenville, IL
Best answers
0
We have the same issue! My doctor dictates the anterior instrumentation is completely separate from the cages in the operative report now and I underline it in that report. I also bill 22845-59. I was told by BCBS they will always deny 22845-59 and then I have to appeal and it always takes so long to get payment! several appeals later.
Yes its so frustrating! Like no matter what you do they won't accept it. Especially BCBS they're horrible.
 

kellz0913

Networker
Messages
25
Location
Bensenville, IL
Best answers
0
We have the same issue! My doctor dictates the anterior instrumentation is completely separate from the cages in the operative report now and I underline it in that report. I also bill 22845-59. I was told by BCBS they will always deny 22845-59 and then I have to appeal and it always takes so long to get payment! several appeals later.
Is there anything else that you do that you know of that gets it paid? I've underlined it in the OP Report and also sent letters and it seems that nothing is working.
 
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