22845 with 22853

kellz0913

Networker
Messages
27
Location
Bensenville, IL
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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

Guest
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20
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
27
Location
Bensenville, IL
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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.

Thanks so much! Is there a certain letter that you send in?
 

MZoltek3

Guest
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20
Location
Mt. Laurel, NJ
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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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8
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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
27
Location
Bensenville, IL
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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.
Yes its so frustrating! Like no matter what you do they won't accept it. Especially BCBS they're horrible.
 

kellz0913

Networker
Messages
27
Location
Bensenville, IL
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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.
 
Messages
7
Location
Va Beach, VA
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We have this issue with Medicaid VA when a cage 22853 and plate 22845,59 are done on the same level.
Denials after notes are sent and appeals are followed up on. We underline operative note and send letter
explaining the difference/separate structure.
 
Messages
75
Location
Sulphur, KY
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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?
I don’t have trouble in KY when my MD puts in the “procedure performed” anterior plate depart and distinct from inter body device and he also dictates a separate and distinct “manufacturers name” plate was placed with one screw “top level” and one screw “bottom level”. I haven’t needed to appeal with this verbiage. It also helps to send in the instrumentation log when you appeal to show you purchased two separate components. Hope this helps.
 
Messages
75
Location
Sulphur, KY
Best answers
0
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.
Anthem is the absolute worse!! Even when I get it preauthorized and explain its separate. They always require appeal with op note and instrumentation log. Drives me nuts!
 
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