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1/1/19 chapter 4 ncci policy manual for medicare services

  1. Default 1/1/19 chapter 4 ncci policy manual for medicare services
    Clearnace Sale
    I have pulled the latest version of the NCCI policy manual and the issue of 22633 and 63047,63042 still has not been updated to allow for separate reimbursement for the decompression at the same level therefore all of our claims are denying for this service. Is anyone dealing with this? Anyone have a fix? We did contact the IMA and they suggested that we bill w 22899 for the 63047,63042 . We are still not having any luck getting paid. The AANS and Karen Zupko both feel that billing the decompression when separate work is being done for stenosis is appropriate while performing a fusion.

    *******CMS payment policy does not allow separate payment for CPT codes 63042 (laminotomy...; lumbar) or 63047 (laminectomy...; lumbar) with CPT codes 22630 or 22633 (arthrodesis; lumbar) when performed at the same interspace. If the two procedures are performed at different interspaces, the two codes of an edit pair may be reported with modifier 59 appended to CPT code 63042 or 63047.

    Also, when billing for an exploration the NCCI states that 22830 should not be reported in the same anatomic area- if it is done in a separate level ex: L2-3 22830 and extending fusion up to L3-4 22633 can we bill both codes ??

    ******10. Exploration of the surgical field is a standard surgical practice. Physicians shall not report a HCPCS/CPT code describing exploration of a surgical field with another HCPCS/CPT code describing a procedure in that surgical field. For example, CPT code 22830 describes exploration of a spinal fusion. CPT code 22830 shall not be reported with another procedure of the spine in the same anatomic area. However, if the spinal fusion exploration is performed in a different anatomic area than another spinal procedure, CPT code 22830 may be reported separately with modifier 59.

  2. Default
    One more addition to the 22830 question, if instrumentation was removed at the level can we bill 22855 in place of 22830? I do not see an NCCI edit on this code.

  3. Wink
    Anyone - any thoughts??

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