confused - I have a confusing question

Messages
8
Best answers
0
Hello Everybody,

I have a confusing question. My doctor performed an arthrodesis and a laminectomy. We billed the following codes:
22630
22851
63047-51
63048
22612
22614
22842
22632
The surgery paid but they denied 63047-51 and asked us to bill 63042-52

Now they reprocessed the claim and they want a refund because supposebly, code 63042-52 lowered the allowed amount. Can this be correct? Please let me know... Thank you...
 

JMeggett

Guru
Messages
226
Location
Spokane Valley, WA
Best answers
0
Hello Everybody,

I have a confusing question. My doctor performed an arthrodesis and a laminectomy. We billed the following codes:
22630
22851
63047-51
63048
22612
22614
22842
22632
The surgery paid but they denied 63047-51 and asked us to bill 63042-52

Now they reprocessed the claim and they want a refund because supposebly, code 63042-52 lowered the allowed amount. Can this be correct? Please let me know... Thank you...
Hi Dana ~ I'm not a super coder on spine stuff, but I have a couple of questions for you to consider. If the date of surgery was after 01/01/12, there is now a combo code that includes both 22630 & 22612 + additional levels.....22633, 22634. So if your DOS is 2012 maybe consider the new codes. Ok, 63047 & 63042 can be for very different things, so don't just let the carrier tell you how this Op should be coded. 63042 is for herniated intervertebral disc, re-exploration. So is that level a re-do of previous Sx? And the Dx linked to that level re-herniated intervertebral disc? 63047 is for stenosis, and can also be used for revision. But if this level of spine is new to Sx and has stenosis then 63047 would probably be more appropriate. It's difficult to know for sure without seeing the op note, but if you have access at all to your Surgeon then maybe check with him to see what he says about that level? Good luck!
Jenna
 
Top