Anthem BCBS is not allowing payment on CPT code 63047 for the surgeon stating it's bundling to 22633. We have a 59 modifier on CPT code 22633 as we billed 63047 as the primary procedure. I know 22633 has more RVUs than 22633, but we billed 63047 as the primary code on the claim due to our fee schedule and contract with Anthem. Can someone help me out of this? They did already pay on code 22633.
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Wiki 63047 and 22633 bundling
- Thread starter alexis.nichole13@hotmail.com
- Start date
jojokat
Networker
Hi, Alexis, this is their policy and they will not budge even when it is at a different level. I have attached their bundled services policy for you. What we do now is enter both charges and adjust off the bundled service before the claim is submitted.
deirdre
Contributor
Even though this code combo is not hitting an NCCI edit, it seems like Anthem had a policy to not allow even with the 59 modifier.
https://www11.anthem.com/provider/n.../pw_g278751.pdf?refer=ahpmedprovider&state=mo
this issue is my Kryptonite. When they brought out this bundled code its been nothing but issues. There is hope to a revised code edit soon
. But No you cannot bill it separate because the code bundles it in. If Decompression is performed at a separate interspace other than the TLIF you can bill it with a -59. Hope this helps.