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allografts denials when billed with spinal surgeries

  1. #1
    Default allografts denials when billed with spinal surgeries
    Medical Coding Books
    Is anyone else receiving rejections from Medicare when CPT code 20931 is being billed with 22551? In the CPT book it states 20931 can be used in conjunction with 22548-22558. I've also read several posts that have said 20931 can be billed with spine surgeries. I'm wondering if this rejection is something that can be appealed or if it's one of those situations where Medicare has it's own rule not to pay for this for their own reasons. Any comments are greatly appreciated.

  2. #2
    Columbia, MO
    what does the rejection state? have you checked the CCI edits. CCI edits are updated quarterly the book is updated annually.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    Ms. Mitchell gives sound advice here. Check the rejection code and work back. The CCI edits can be downloaded from CMS in Excel. Good luck.


  4. #4
    We receive those denials too, and there aren't any CCI edits for that code. The insurance companies just don't pay it.

  5. Default
    I dont receive denials for code 20931. Medicare does not pay for code 20930 or 20936, but they do pay for the graft codes 20931, 20937 and 20938. My guess is that your local Medicare carrier or Medicare HMO or PPO has not updated their system to connect code 20931 with 22551. If you are receiving denials, I would appeal your Medicare carrier with a copy of the CCI edits showing that there is no edit that prevents the billing of these codes together along with a letter stating that a fusion can not be done without a graft, this is a recognized graft code and there are RVU's established for this code and they should most certainly be paying for it.

    Thank you,

    Kristi Kemick, CPC

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