Wiki Spinal Instrumentation Codes - I wanted to know if there are any

[lewisbr]

Hi fellow coders, I wanted to know if there are any other coders having the same trouble I am having with Medicare with getting codes 22840-22848 codes set paid by Medicare when they are billed with the proper primary procedure code. Example, we sometimes perform 22551 ( Arthrodesis, anterior interbody fusion along with 22845,80) My physician does a lot of co-surgeon work with a neuro surgeon but when we are the assist we bill the 80 on 22845, and Medicare never pays we always have to appeal for payment, when CPT clearly states 22845 must be billed with a primary code. Does anyone else have this trouble? or there any suggestions on how to resolve this issue with Medicare? thanks for your input.

 

[mhstrauss]

"My physician does a lot of co-surgeon work with a neuro surgeon but when we are the assist we bill the 80 on 22845, and Medicare never pays we always have to appeal for payment, when CPT clearly states 22845 must be billed with a primary code."


In this situation, is 22845-80 the only code you are billing for the case? Per the RVU file, 22845 does allow assist without payment restrictions, but yes, it does have to have a primary code billed with it. If your surgeon is only assisting for the instrumentation, and not the rest of the surgery, you will have to bill an unlisted code, since there is no primary code for your surgeon to bill with the 22845. If he is assisting with the entire surgery, and you are billing the primary codes, all with mod 80, not sure what the problem could be. What exactly is the denial?

 

[lewisbr]

Spinal Instrumentation Codes

Actually, we are billing the primary codes with modifier 62, as our spinal surgeon functioned as a co-surgeon for the procedure; however, the instrumentation add-on codes are billed (same claim) with the modifier 80 when the patient is the neurologist's; and billed without a modifier when the patient is ours. So, the primary code is billed with modifier 62 and the instrumentation add-on code is billed with modifier 80.

 

[mhstrauss]

Actually, we are billing the primary codes with modifier 62, as our spinal surgeon functioned as a co-surgeon for the procedure; however, the instrumentation add-on codes are billed (same claim) with the modifier 80 when the patient is the neurologist's; and billed without a modifier when the patient is ours. So, the primary code is billed with modifier 62 and the instrumentation add-on code is billed with modifier 80.

Oh ok, I see. The use of both co- and assist modifiers on the same claim may be causing the confusion. I would think payers would expect that to match. I can see the reasoning for using 80 on the instrumentation codes, but have you tried using a 62 on them instead? 22845 has an indicator of 2 also, which does allow for co-surgeon payment without restriction, provided that the "2 specialties" rule is met, which sounds like it is in your case.
Not sure what other angle to look at this from