Wiki Back case TLIF

carol52

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Hello, can someone please help me with this surgery ?
Lumbar Stenosis with radiculopathy

Procedure: TLIF L4-5, L5-S1 utilizing Zimmer interbody expandable cage between L4 and L5 filled with allograft and interbody expandable cage filled with allograft between L5-S1, posterior spinal fusion L4-5, L5-S1
utilizing autograft and allograft Zimmer screws in L4-
L5 bilaterally and in S1 bilaterally.
Lumbar decompressive laminectomy L4-5 and L5-S1 with bilateral full facetectomy, L4-5 and right sided full facetectomy at L5-S1 with bilateral full facetectomy L4-5 right sided and full facetectomy at L5-S1 with nerve root decompression.
Thanks
Carol
 
TLIF with posterior spinal fusion L4-5 and L5-S1= 22633 22634 22853X2
Instrumentation L4-S1= 22842
Decompressive lami with F and F L4-5, L5-S1--assuming this is more than just for creating the interspace..if documentation support additional work for the stenosis 63052 63053
autograft/allograft, typically 20930/20936 bundle as they are status b codes but some payors (not medicare, or govt payors) will reimburse so added just in case you need them
 
TLIF with posterior spinal fusion L4-5 and L5-S1= 22633 22634 22853X2
Instrumentation L4-S1= 22842
Decompressive lami with F and F L4-5, L5-S1--assuming this is more than just for creating the interspace..if documentation support additional work for the stenosis 63052 63053
autograft/allograft, typically 20930/20936 bundle as they are status b codes but some payors (not medicare, or govt payors) will reimburse so added just in case you need them
Have you had luck with payors reimbursing 63052 and 63053 when billed with 22633 and 22634? We used to bill 63047 and 63048 for the decompressive laminectomy done during the fusion with docum of addt'l work that was beyond the fusion but payors still denied as global. My neurosurgeon always documents in detail the addt'l work performed in his operativ reports but the payors still deny and I appeal and still same denial. Is it better with 63052 and 63053?
 
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