Wiki 63052/63047

[ms.bones206]

I know what to do with the 22840 and the 22853. My questions is to confirm the 63047 at the L3-L4 because it doesn't have the arthrodesis/fusion. I'm ruling out 63053 because it doesn't have a fusion at that level and the 63048 because it can't be used without the 63047. I use the -59 because of the NCCI edit. It says NCCI-associated modifier can override the edit under appropriate circumstances - which I take this as a valid circumstance. Does anyone have a different/better/proven way to code this scenario? Thank you in advance.

L1 2 laminectomy with left-sided approach for stenosis

L3-4 laminectomy right-sided approach for stenosis

L4-5 laminectomy and fusion right-sided approach

22633 Level L4-L5
63052 Level L4-L5
63047 -59 Level L3-L4
63048 Level L1-L2

 

[kamalpal]

Well.. This is the correct approach to bill the above operative notes with XU modifier. Rest depends on the payer policy if they denied you can suggest for follow up with completed medical record's if patient having pre-authorization for all billed Cpt codes.