Wiki TLIF's with a lami 22633/63047 or 63042

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atheri992

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I want a second opinion please because our spine surgery office does many transforaminal lumbar interbody fusions BUT they also are doing decompressive laminectomies/reexplorations at the same level . From what I've read, Medicare and government insurances will deny the 63047/63042 no matter what reason because they state at the same level, they are just preparing the interspace for the fusion. For commercial carriers, they say you CAN report the 63047 with a modifier if performed for decompression. My spine surgeons document well it's a decompressive laminectomy and throughout the op report it's separate as decompression related and I do put a different primary DX on the claim (such as stenosis to reflect this).

My question is...on the Medicare/Medicare Advantage ones, should I be coding the 63047 or 63042 but just put no modifier to leave unbundled and "show the work" or should I just leave them off entirely?

What's everyone doing for these?

Thank you so much for any assistance and opinions!
Angela
 
I was billing the decompressions to Medicare with out the modifier but I was having a problem where they would deny 63047 and then pay the 63048 codes. This was a huge mess so now I do not add the decompression codes to any Medicare products.
 
That is so strange they would do that! Makes zero sense! It's definitely easier to leave it out but I just don't want to shortchange the docs on RVU payments just because insurance bundles everything. I highly doubt the RVU for the TLIF was adjusted for the decompression value being included.
 
atheri992 said:
I want a second opinion please because our spine surgery office does many transforaminal lumbar interbody fusions BUT they also are doing decompressive laminectomies/reexplorations at the same level . From what I've read, Medicare and government insurances will deny the 63047/63042 no matter what reason because they state at the same level, they are just preparing the interspace for the fusion. For commercial carriers, they say you CAN report the 63047 with a modifier if performed for decompression. My spine surgeons document well it's a decompressive laminectomy and throughout the op report it's separate as decompression related and I do put a different primary DX on the claim (such as stenosis to reflect this).

My question is...on the Medicare/Medicare Advantage ones, should I be coding the 63047 or 63042 but just put no modifier to leave unbundled and "show the work" or should I just leave them off entirely?

What's everyone doing for these?

Thank you so much for any assistance and opinions!
Angela
Click to expand...

We are reporting the 63047 with modifier 51 and adjusting off for bundle when the claim processes. AANS tried appealing the CCI Edit decision 2 years ago with no success. Florida Blue and UHC Medicare replacements are not paying that combination either and we are having to adjust it off.
 
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