AT2728
Expert
- Messages
- 326
- Location
- Perryville, MO
We are at a loss here and could use some expert eyes. Below is an exert from the operative procedure for which we are billing 63052 with 63053 x 2 units. UHC is constantly denying 63053 as not documented and we are trying to clarify what they are stating is missing since the provider states L4-5 and L5-S1. I did discuss with a coder who is more familiar with these procedures. Guidance and terminology always stated a vertebral segment is each level, i.e. L4, L5 are two segments. However, this article would imply otherwise. Can anyone explain what we are missing, why it appears vertebral segment in this context differs?
They did provide us with and explanation in regard to UOS and NCCI edits, but we are still a bit perplexed.: Per NCCI Policy Manual Chapter General Correct Coding Policies, physicians must report Units of Service correctly. The narrative report is insufficient to support the UOS requested. A physician shall not report UOS for a CPT code using a criterion that differs from the code's defined unit ot service. As such, the request for CPT code 63053 is denied as not documented.
Operative report section:
Attention was next turned to the decompression and posterior lumbar inter body fusion phase of the surgery. C-arm fluoroscopy was used to identify the L4-5 and L5-S1 interspace and a midline incision was then planned. The incision was then injected with 10cc of 1% lidocaine with epinephrine. The incision was then made with a #10 blade and carried down through the subcutaneous tissue with bovie cautery. The fascia was exposed and dissected off the intraspinous ligament and spinous process bilateral. The paraspinal muscle was dissected in a subperiosteal dissection to the lateral aspect of the facets. Self retaining retractors were placed and fluoroscopy was brought in to confirm the L4-5 and L5-S1 levels.
A laminectomy with complete medial facetectomy was then carried out bilateral at L4-5 and L5-S1 using a combination of the high speed drill, Kerrison ronjeurs, Leksell ronjeurs, and curettes. The microscope was brought into the operative field to complete the neuroforaminal decompression
Any assistance/advice would be greatly appreciated.
They did provide us with and explanation in regard to UOS and NCCI edits, but we are still a bit perplexed.: Per NCCI Policy Manual Chapter General Correct Coding Policies, physicians must report Units of Service correctly. The narrative report is insufficient to support the UOS requested. A physician shall not report UOS for a CPT code using a criterion that differs from the code's defined unit ot service. As such, the request for CPT code 63053 is denied as not documented.
Operative report section:
Attention was next turned to the decompression and posterior lumbar inter body fusion phase of the surgery. C-arm fluoroscopy was used to identify the L4-5 and L5-S1 interspace and a midline incision was then planned. The incision was then injected with 10cc of 1% lidocaine with epinephrine. The incision was then made with a #10 blade and carried down through the subcutaneous tissue with bovie cautery. The fascia was exposed and dissected off the intraspinous ligament and spinous process bilateral. The paraspinal muscle was dissected in a subperiosteal dissection to the lateral aspect of the facets. Self retaining retractors were placed and fluoroscopy was brought in to confirm the L4-5 and L5-S1 levels.
A laminectomy with complete medial facetectomy was then carried out bilateral at L4-5 and L5-S1 using a combination of the high speed drill, Kerrison ronjeurs, Leksell ronjeurs, and curettes. The microscope was brought into the operative field to complete the neuroforaminal decompression
Any assistance/advice would be greatly appreciated.
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