GMMTimmons

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We have recently received a Medicare denial for a claim billed out for Kyphoplasty.
22513 x 1
22514 x 1

CCI edit states the family of codes (22513-22515) should only list "One" as the primary code and list the other as add on procedure for the additional level, which we normally do when done in the same region. However in this scenerio, it was done in two regions and the edit states "Whether the additional level(s) are contiguous or not.
Should this have been billed out as:
22513 x1
22515 x1
or since these procedures were done in the "Thoracic T-6 and Lumbar L-4" both...should we have appended modifier "XU" with the original codes billed?

I'm having a debate with the doctor's office and could use something concrete. Any help would be appreciated.
 

such78

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260
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Baldwin Park, CA
Best answers
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We have recently received a Medicare denial for a claim billed out for Kyphoplasty.
22513 x 1
22514 x 1

CCI edit states the family of codes (22513-22515) should only list "One" as the primary code and list the other as add on procedure for the additional level, which we normally do when done in the same region. However in this scenerio, it was done in two regions and the edit states "Whether the additional level(s) are contiguous or not.
Should this have been billed out as:
22513 x1
22515 x1
or since these procedures were done in the "Thoracic T-6 and Lumbar L-4" both...should we have appended modifier "XU" with the original codes billed?

I'm having a debate with the doctor's office and could use something concrete. Any help would be appreciated.

22513 for thoracic +22515 for lumbar , or 22514 for lumbar + 22515 for thoracic

22515 is an add-on code for thoracic or lumbar vertebral body

The following are some additional guidelines for vertebroplasty and vertebral augmentation (kyphoplasty)

•Vertebroplasty and vertebral augmentation procedures include, bone biopsy when performed, moderate sedation, and the imaging guidance necessary to perform the procedure.

•One primary procedure code is reported with an add-on code for each additional level to which the procedure is performed.

•The sacrum and sacral procedures are reported only once per encounter.


Only a few of ICD-10-CM codes are billable for this procedure per LCD.
 
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