Spine coding assistance needed

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I have a denied medicare claim for codes 22842 and 22851 on a 2 level lumbar fusion saying that the "mother" code is not recognized. In the new cpt book, they forgot to list the new revised code of 22633 as the mother code. Now medicare is denying. Anyone else with this problem by chance? What is the way around this?
Thanks!
 
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Absolutely. I posted: 22633, 22634, 22842, 22851, 22851-59. Medicare will pay for the first two, but not the last three claiming that the "mother" code is not listed on claim.

Other claims sent to BCBS and Tricare have paid. Go figure........

Any ideas?
 

ewinnacott

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I ran the codes through Code Correct and there is no bundling issues. The only thing I can think of is that you need to bill 22851 x2 units instead of 22851,22851-59. I've never billed the 22851 separately like that and we've been paid. Honestly I can't think of anything else. Maybe by doing the written redermination and removing the 22851-59 and billing 22851 x2 will get the claim ran through again and all the codes will pay.
 

nyyankees

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I have a denied medicare claim for codes 22842 and 22851 on a 2 level lumbar fusion saying that the "mother" code is not recognized. In the new cpt book, they forgot to list the new revised code of 22633 as the mother code. Now medicare is denying. Anyone else with this problem by chance? What is the way around this?
Thanks!

CPT needs to update these new codes to allow the Instrumentation codes + bone grafts. I would appeal based on old 22612 and 22630 codes..
 
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Have contacted Medicare. No code listed as eligible, no paying of instrumentation and intervertebral implant. Period.
I then contacted AMA, the author of the CPT book and was told that they don't answer coding issues over the phone. I could email a question after registering with the AMA and paying a nominal fee.
I only have this issue with Medicare. (Go figure.....)
Unfortunately I cannot use the 2011 codes of 22612 and 22630 because the 2012 CPT book forbids it.
HELP! Losing my mind!
 

RebeccaWoodward*

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Clarification of New CPT Codes 22633 and 22634 for Arthrodesis

For 2012, two new CPT codes - 22633 and 22634 - have been established to report lumbar arthrodesis using a combined posterior or posterolateral technique with a posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression) for each interspace and segment.
Bone grafting (codes 20930-20938) and spinal instrumentation (codes 22840-22851) are often performed during the same operative session when performing arthrodesis procedures whether they are posterolateral (22612), posterior lumbar interbody (22630), or combined posterolateral and posterior lumbar interbody (22633). However, the CPT instructions inadvertently omitted codes 22633 and 22634 from the parenthetical notes for the graft and instrumentation codes. Based on these guidelines, you may experience denial of payment for graft and instrumentation billed with code 22633.
NASS has discussed this omission with the American Medical Association's (AMA) CPT Editorial Panel, and we together with other medical societies are working with the AMA to correct the parenthetical instructions to include 22633 and 22634 with the other arthrodesis codes as being properly reportable with instrumentation and bone grafting. We are hopeful that by working together, we will have this resolved by the middle of 2012. The AMA has discussed several possibilities for notifying providers and insurers and believes a CPT Assistant article as well as a clarification on its website may be appropriate vehicles for disseminating the updates.
At this time, NASS recommends holding any denials of payment and submitting an appeal once the coding clarification is published later in the year. NASS will inform all members when the policy has been update

http://www.aans.org/pdf/Legislative/Washington_E-newsletter/WashingtonNews2012Vol8.pdf
 
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EricaWildinger

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Spine Coding

I'm only 2 months into spine coding and have a denial here from Medicare...the CPT codes billed are as follows: 22214, 22633, 20936, 20931 63047, 63048 (x3), 22612, 22614 (x3) , 22610, and 20842. Medicare denied 22612 and 22614 and we haven't been paid for any allografts or autografts (is this normal for grafts?). Is everybody saying that they Medicare will not pay for any add'l arthrodesis unless it is 22634 for each segment/interbody? According to RebeccaWoodward* they won't have it "fixed" until middle of the year...since Medicare denied and if we send claim back, will it fall under the 120 day rule with refiling a claim after a denial? :confused:
 

RebeccaWoodward*

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I'm only 2 months into spine coding and have a denial here from Medicare...the CPT codes billed are as follows: 22214, 22633, 20936, 20931 63047, 63048 (x3), 22612, 22614 (x3) , 22610, and 20842. Medicare denied 22612 and 22614 and we haven't been paid for any allografts or autografts (is this normal for grafts?). Is everybody saying that they Medicare will not pay for any add'l arthrodesis unless it is 22634 for each segment/interbody? According to RebeccaWoodward* they won't have it "fixed" until middle of the year...since Medicare denied and if we send claim back, will it fall under the 120 day rule with refiling a claim after a denial? :confused:

The grafts aren't payable by Medicare (allo/autografts). Other carriers do pay for them but this will become carrier specific. As for the "fix"...we filed our claims so that we had proof that we submitted our claim within the timely filing limit. We're going to work the denials on the back end.
 

EricaWildinger

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RebeccaWoodward*...ok, that's what I figured would happen. Now, since we billed the 22633 with a 22612 and a 22614, why wouldn't Medicare pay these? They state they are included in 22633, but they were at different levels. Do I just need to add a modifier to indicate a separate procedure? I'm really confused...
 

RebeccaWoodward*

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RebeccaWoodward*...ok, that's what I figured would happen. Now, since we billed the 22633 with a 22612 and a 22614, why wouldn't Medicare pay these? They state they are included in 22633, but they were at different levels. Do I just need to add a modifier to indicate a separate procedure? I'm really confused...

If these were performed at different levels, I have been successful at appealing with 59 and the op note. Below are the NCCI edits...

22633 22612 20120101 * 1

1=modifier allowed

http://www.cms.hhs.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html
 
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