Wiki CPT 22845 Billing This Out with 22853

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We are Orthopedic Clinic and we are just having problems billing out cpt 22845 w/22853 does anyone else having this issue, Per are DR. he said when he does the cage procedure he is doing the instrumentation separate, but we are getting this denied stating this is a bundle code.

If anyone is having this problem could let me know how you are handing this.

Thank You

Carol R, CPC
 
Notes from Encoder

I am such a newbie but found the following notes on the encoder I use, TCI Supercoder. Both 22853 and 22845 appear to be add-on codes.

Use 22853 in conjunction with 22100-22102, 22110-22114, 22206, 22207, 22210-22214, 22220-22224, 22310-22327, 22532, 22533, 22548-22558, 22590-22612, 22630, 22633, 22634, 22800-22812, 63001-63030, 63040-63042, 63045-63047, 63050-63056, 63064, 63075, 63077, 63081, 63085, 63087, 63090, 63101, 63102, 63170-63290, 63300-63307


Use 22845 in conjunction with 22100-22102, 22110-22114, 22206, 22207, 22210-22214, 22220-22224, 22310-22327, 22532, 22533, 22548-22558, 22590-22612, 22630, 22633, 22634, 22800-22812, 63001-63030, 63040-63042, 63045-63047, 63050-63056, 63064, 63075, 63077, 63081, 63085, 63087, 63090, 63101, 63102, 63170-63290, 63300-63307
 
22853 and 22845

You need to append a modifier 59 to 22845. Carriers want proof that you actually used a separate plate with the cage. If you use an integral cage and plate you cannot bill 22845.
 
billing 22845 with 22853

I agree with the above note. 22845 is the higher RVU code, so 22853 needs a 59 modifier. I have not had a rejection billing it this way. Just make sure the surgeon is very specific in the operative report that the hardware is separate from the cage and not integral to the cage.

Laurel Wisniewski, CPC
 
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