Wiki Spine Surgery Coding Question

[shenell333@yahoo.com]

Hello I have a physician coding question. A neurosurgeon & orthopedic doctor performed a lumbar spinal fusion on a patient here's a short scenario.



The neurosurgeon performed the decompression on 3 levels from L3-S1 he Widened out the laminectomies, undercutting the pars of L3 doing a foraminotomy of the L3 nerve root and medial facetectomy 3, 4, foraminotomy of L4, medial facetectomy of 4-5, and forminotomy of L5, and a medial facetectomy of 5-1 and foraminotomy of S1. Once they got good decompression he assisted on the fusion on all three levels also performing posterior Instrumentaion on 4 vertebral segments they also used interbody grafts.



We coded the following:

63047-59

63048-59 x2 units

22842

22633-80

22634-80 x2 units

22851-80

My question is humana medicare adv plan pd all lines except 63047, 63048. The operative clearly states the decompression was more than whats included in code 22633 but they are trying to bundle stating global service data. Is there a incident to on those codes done together? If you have any reference material in regards to AAOS Global Service Data I would preciate a copy if available.

 

[amyhw7s@gmail.com]

Hello I have a physician coding question. A neurosurgeon & orthopedic doctor performed a lumbar spinal fusion on a patient here's a short scenario.



The neurosurgeon performed the decompression on 3 levels from L3-S1 he Widened out the laminectomies, undercutting the pars of L3 doing a foraminotomy of the L3 nerve root and medial facetectomy 3, 4, foraminotomy of L4, medial facetectomy of 4-5, and forminotomy of L5, and a medial facetectomy of 5-1 and foraminotomy of S1. Once they got good decompression he assisted on the fusion on all three levels also performing posterior Instrumentaion on 4 vertebral segments they also used interbody grafts.



We coded the following:

63047-59

63048-59 x2 units

22842

22633-80

22634-80 x2 units

22851-80

My question is humana medicare adv plan pd all lines except 63047, 63048. The operative clearly states the decompression was more than whats included in code 22633 but they are trying to bundle stating global service data. Is there a incident to on those codes done together? If you have any reference material in regards to AAOS Global Service Data I would preciate a copy if available.

Hi Sherrie,
Have you found any reference material on this issue?

Amy Scott

 

[shenell333@yahoo.com]

No I did not. But we did a peer to peer and it was successful they paid.

 

[taparker]

Watch modifier 59 on your add-on codes, like 63048. I know we've had to start using modifier 76 on them per Cahaba.

We've also found that a large number of insurance providers won't accept a quantity of more than one. We have to bill it like this:

63047-59

63048-76

63048-76

22633-80

22634-80-76

22634-80-76

22842

22851-80

 

[shenell333@yahoo.com]

Yeah I know this surgery was before the new changes by cms we to have made those changes when using modifier 59 for repeat procedures on three or more levels.