Wiki TLIF & PLIF

[dianegodfrey@comcast.net]

I need to do a prior authorization for a TLIF at L4-5 and a PLIF at L5-S1, I have coded for a PLIF by itself and a TLIF by itself but never together. PLIF and TLIF are both coded with 22633. I do not think that I can bill 22633 twice so I would have to do an additional level of 22634 correct? would I use a modifier 22 increased procedure? The doctor said that he can't get to the L5-S1 to do a TLIF, I am assuming because of his anatomy, so he can only do a PLIF. It will also include hardware 22842 for L4-S1 and cage 22853 x2 also 20930 bone graft (DBM - I-factor) Also, I should be able to use new code 63052 and 63053 for Laminectomy. Does any one have any additional advise before I send in to pre-auth? Thank you for any advise and or options.

 

[amyjph]

No 22 it would have to be clearly documented at the time of the procedure that it was increased. It's a two level interbody. 22633, 22634, 22842, 22853x2, 20930 (if payer covers), yes you could add 63052, 63053 if lami planned. If attachment to the pelvis 22848 but probably not if it's only a two level those are usually for bigger fusions.

 

[dianegodfrey@comcast.net]

Thank you !!