Wiki Anterior Plate Payment

[sarab86]

Im curious who else is having this issue. I am running into a tread of denials from UHC Medicare plan for the anterior plate(22845/22846) when billed with an Interbody Device for ACDF cases. This plate is a complete separate device to provide independent stabilization and NOT Integral Anchoring. No matter what I sent to support this Optum is still claiming it is not documented and they keep referencing the CPT Description for 22853. I know this is a mass misinterpretation of the new CPT description but I cant get them to understand. I have even sent the product catalog picture and descriptions from the manufacturer for both the Interbody Device and Plate.

Any one else have any luck with this? We bill 22845/22846 with modifier 59 and even a different DX of vertebral instability with no luck.

 

[tmarugg]

I've got the same problem....

We are experiencing the same issue but not only with UHC we also get denials from just about every commercial payer. When I submit an appeal/reconsideration I've been including the following:
#1) a screenshot of the updated CCI edit allowing the use of modifier-59 on CPT code 22845
#2) the article from AAPC dated March 2017 indicating that device anchoring is found is some plating systems but not all
#3) product information from each manufacturer that has pictures of the devices being used
#4) operative report
#5) a letter that I drafted which (hopefully) 'connects the dots' for whoever is doing the review

Sometimes it will get paid after submitting all of this information, sometimes it doesn't.

Since I'm in Texas, for those that don't get paid, I submitted a Hassle Factor Log to the TMA with all of my documentation. I'm still waiting for a response on those though.

It seems like the payers have yet to recognize the fact that modifier-59 is allowed for 22845.

Hope this helps!

Tammy Marugg, CPC

 

[sarab86]

Thanks for answering! Im in Florida so reaching out to any state authority is costly. I tracked down the new CEO of UHC and Optum and just sent them a letter. Hopefully i can get someone to actually look at everything. Ive had luck in years past for other issues but then they restructured everything.