Wiki HELP--63047 and 63048


Best answers
Can anyone help me with finding a good resource for these codes.

I am receiving rejections stating that 63047 and 63048 are denied when submitted with procedure codes 22630 and 22632.

Any suggestions?

Thank you. Terri

I know this may overwelming, as far as reading material, but you can never have too much for Neurosurgery. This happens to be one of my specialites. The last link is a freebie from the coding Institute. They are a lifeline at times. If you still have questions, send a message to me directly.
Try CCI Edits

check CCI edits, link provided below. under the link there is the NCCI Policy Manual link-this takes you to the instructions for each chapter of the CCI manaul (ex codes 20000). There is valuable information within the instruction/guideline section.

For code 22630, 63047 is a component of 22630, there is a modifier indicator
"1", so if appropriate a modifier may be necessary (normally 59). Don't forget to check the mutually exclusively table also. I was unable to open it on my computer. I have Microsoft Vista and unable to open some links.

NCCI Policy Manual for Part B Medicare Carriers [PDF/ZIP 485KB]

Medicare Claims Processing Manual (Sec. 20.9) [PDF, 1.2MB]

Modifier 59 Article: Proper Usage Regarding Distinct Procedural Service [PDF, 20KB]

Hope this helps:)
I have a program on my computer called Code Manager published by the AMA. It is indispensable, I use it almost daily. It has CPT, ICD-9, CCI edits, and clinical vignettes that I use for appeals. Below is an example of a vignette regarding your question about 63047 reported with 22630:

January 2001 page 12


The descriptors of codes 22554 and 22630 describe anterior (22554) or posterior (22630) interbody technique arthrodeses to include laminectomy, and/or diskectomy to prepare the interspace (other than for decompression). In what procedural circumstance would the 63001-63048 code(s) be reported in addition to code 22630? Similarly, in what procedural circumstance would code(s) 63075-63078 be reported in addition to code 22554?

AMA Comment

To report code 22630, Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace (other than for decompression), single interspace; lumbar, in addition to code 63047-51, Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root, [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar, again additional procedure(s) must have been performed. For example, in spinal procedures performed on patients having lateral lumbar stenosis, the surgeon may need to perform additional work above and beyond that described by the PLIF, including facetectomy(ies) and/or foraminotomy(ies), to adequately decompress the nerve roots. For the purpose of this example, code 63047-51 should be reported in addition to code 22630.

Hope this helps!