Results 1 to 2 of 2

59 Modifier and RVU's - The spine surgeon did a re-exploration

  1. #1
    Default 59 Modifier and RVU's - The spine surgeon did a re-exploration
    Medical Coding Books
    The spine surgeon did a re-exploration of hemilaminectomy at L5-S1 (63042) and a laminectomy at L3-4 and L4-5 (63047, 63048). I code according to RVU's. 63042 has a higher RVU than 63047. However, 63042 is bundled with 63047. Insurance is denying the 63042 as inclusive. From what I have found on internet, it is not appropriate to put 59 modifier on primary procedure. These procedures are done at different levels, and the surgeon should get paid for them. Does anyone have suggestions about this?

  2. #2
    North Carolina
    Our practice is also affected by this payment methodology but unfortunatley, I see no way around it. 63042 has work RVU's of 18.61 63047=15.22

    63047 has a payment status indicator 2. Therefore, most carriers will follow the payment policy below:

    Standard payment adjustment rules for multiple procedures apply.

    If a procedure is reported on the same day as another procedure with an indicator of 1, 2, for 3, you will need to rank the procedures by fee schedule (RVU's) amount and apply the appropriate reduction to the secondary codes (100%-50%-50%......)

    Also...I don't see where NCCI edits bundle 63047 into 63042. I would append 51 to 63047. However, the multiple payment reduction will still apply.
    Last edited by RebeccaWoodward*; 04-08-2009 at 11:59 AM.

Similar Threads

  1. RVU's
    By michelleaapc2012 in forum Billing/Reimbursement
    Replies: 1
    Last Post: 04-02-2014, 08:33 AM
  2. RVU's
    By LStana in forum Orthopaedics
    Replies: 2
    Last Post: 05-14-2013, 07:22 AM
  3. do you read the rvu schedule
    By bscott in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 01-12-2012, 04:45 PM
  4. Trial SCS & facility rvu's vs non-facility rvu's
    By djarrett in forum Anesthesia
    Replies: 3
    Last Post: 10-11-2011, 02:49 PM
  5. RVU's for 62 and 80 Modifier
    By 01062416 in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 07-01-2009, 08:04 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.