Wiki Artificial Disc Replacement + ACDF Same Op Session

[katic23]

Hello,

We received a pre-determination and a pre-authorization from Highmark BCBS for a combo single level artificial disc replacement, plus a single level ACDF to be performed in the same operative session. I coded this procedure as 22856-59, 22551, 22845, 22851, 38220-59, 20930 & 20936. I have been paid for the ADR (22856) and the R ICMBA(38220-59), but the codes 22551, 22845 & 22851 are bundling despite the modifier -59. What, if any are my other options for reporting this procedure correctly b/c BCBS is denying at this time? I appreciate any feedback.

 

[mhstrauss]

Hello,

We received a pre-determination and a pre-authorization from Highmark BCBS for a combo single level artificial disc replacement, plus a single level ACDF to be performed in the same operative session. I coded this procedure as 22856-59, 22551, 22845, 22851, 38220-59, 20930 & 20936. I have been paid for the ADR (22856) and the R ICMBA(38220-59), but the codes 22551, 22845 & 22851 are bundling despite the modifier -59. What, if any are my other options for reporting this procedure correctly b/c BCBS is denying at this time? I appreciate any feedback.

Per the NCCI Edits, 22551, 22845, and 22851 are Column 2 edits of Column 1 22856. And since 20930 and 20936 are add-ons to 22551, they didn't get processed either. IMO, the claim should have been billed as:

22856
22551-59
22845-59
22851-59
38220
20930
20936

Hope this helps!

 

[katic23]

I will give it a try! Thank you so very much.

Katie

 

[mhstrauss]

I will give it a try! Thank you so very much.

Katie

You're quite welcome! Let us know how that turns out; I'm curious!

 

[katic23]

It worked! I just received the payment today.