Wiki coding multiple levels of spinal fusion

[anicole76]

I am an insurance/coding representative for a Neurosurgical Center and we are receiving conflicting information regarding coding multiple levels of a spinal fusion. We are currently coding them as follows:
22612 X1
22614 X1
22614 X1 -76
22614 X1 -76
We have recently received direction from an outside source that specializes in Neurosurgery that individual line items with modifier -76 is not appropriate for the add-on codes, and it should be:
22612 X1unit
22614 X3 units
After extensive research with our available coding resource websites to no avail, two calls were placed to Medicare for clarification. The first time we were told that the way we are coding is correct...the second time we were told that add-on codes for additional levels of the fusion should be billed with multiple units.
Although payer guidelines vary and we are being reimbursed as/is, our goal is to ensure that we are coding appropriately to prevent a future audit. If anyone has any feedback regarding your experience, or where we could locate documentation for clarification, it would be greatly appreciated. Thank You!

 

[OCD_coder]

Using modifier 76 is a repeat procedure at the same level when applied with the 22614. I have billed spinal infusions for years and have always billed the total number of units 22614 x 3, not as line items with modifiers. I don't think I have ever gotten a denial when we bill this way.

Add-on codes have a ZZZ global status indictor (no global period), the modifier of the base code (22614) covers the add-on code and the global period is assigned to the base code. We educate our surgical coders to avoid using modifiers on add-on codes as any modifier on the base code applies to the add-on code. So if you add a modifier 80 to the 22612-80, it applies to the 22614.