Wiki Spinal Surgery question

[dianegodfrey@comcast.net]

Need advise Please. Doctor did a TLIF at L3-L4 and L4-L5 on the left. Also, did a Posterolateral fusion on the left side at L3 and L4. Then he did Laminotomy at L5-S1 with foraminotomy.
I billed 22633, 22634, 22853 (2 units). I also billed 63052 and 63053 for Laminectomy during interbody fusion for the levels L3-L4 and L4-L5. I billed 63030-59 for the laminotomy. BCBS denied the 63030-59 stating inconsistent with the modifier used. I called BCBS and of course they we no help, they said to just file a corrected claim for that code. What is there to correct? L5-S1 should be paid because it is not part of the fusion thus modifier 59 added for distinct procedural service Any advise is appreciated so I can refile the claim. Thank you.

 

[jrclark1987@yahoo.com]

TO clarify 2 level TLIF with decompression and interbody device 22633,22634,22853 X2,63052,63053 (instrumentation, bone graft) coded and submitted with appropriate Diagnosis attached (e.g., stenosis, listhesis, spondy) then you coded 63030-59 L5-S1 with separate appropriate Diagnosis attached (e.g., herniation)? Denial was inconsistent modifier. Did you look at the BCBS modifier policy on the provider portal? Do they prefer XU/XS over -59? Are they requiring LT/RT because this code is appropriate for -50? Payers in my area changed a lot of policies last quarter on preference. I would start there. It may be a simple educational opportunity for the staff on BCBS policy. If submitted per that policy I would submit reconsideration letter attaching that policy. hope this helps.