Medicare Compliance & Reimbursement
Assess Multiple Procedures Across Multiple Spinal Levels
Question: During an operative session, my neurosurgeon performed the following procedures: L4"L5 diskectomy, L5"S1 diskectomy, L4"L5 transforaminal interbody fusion using posterior interbody technique, L5"S1 transforaminal interbody fusion using posterior interbody technique, bone graft placement (autograft), L4"L5 interbody cage placement, L5"S1 cage placement, and L4, L5, S1 bilateral pedicle screw instrumentation. How should I report this procedure? Answer: From the description you provide, your surgeon likely performed a transforaminal lumbar interbody fusion (TLIF) procedure. If the surgeon performed the L4"L5 transforaminal interbody fusion using a posterior interbody technique, you should report 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace [other than for decompression], single interspace; lumbar). For the L5"S1 interbody fusion, you should report +22632 (... each additional interspace [List separately in addition to code for primary procedure]). Then, report the appropriate autograft code (20936"20938) for the autograft. Next, bill one unit of +22851 (Application of intervertebral biomechanical device[s] [e.g., synthetic cage(s), threaded bone dowel(s), methylmethacrylate] to vertebral defect or interspace [List separately in addition to code for primary procedure]) to represent the surgeon's work inserting the interbody cage at L4"L5. Then, report another unit of +22851 for the L5"S1 cage placement. Append modifier 59 (Distinct procedural service) to show the payer that your neurosurgeon addressed separate levels. Also, you should report +22842 (Posterior segmental instrumentation [e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires]; 3 to 6 vertebral segments [List separately in addition to code for primary procedure]) for the screw instrumentation. Because the code's descriptor refers to "3 to 6 vertebral segments," you can report only one unit of this code, despite the fact that the surgeon inserted screws at three levels. Don't miss: Because your neurosurgeon only documented a simple diskectomy (meaning as preparation for the fusion, not for the decompression), you wouldn't report codes 63030 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk, including open or endoscopically assisted approach; 1 interspace, lumbar) and +63035 (... each additional interspace, cervical or lumbar [List separately in addition to code for primary procedure])
Medicare Compliance & Reimbursement
- Recovery Audit Contractors:
RACs ID Insufficient Documentation As Weakness Among Practices
Stay on top of RAC requests so you're able to meet all request deadlines. Recovery [...] - Medicare Payment:
CMS Reps Outline Impact of PPACA on 2011 Fee Schedule
Plus: Medicare enrollment Web site adds additional resource files. The ink is barely dry on [...] - Part B Coding Coach:
FAQs: Double Your E/M Payout on Some Counseling 'Domination' Claims
Here's when you can code past the three E/M component levels. The physician provides an [...] - E/M Best Practices:
Master New Patient E/Ms or Leave Cash on the Table
Financial fallout can be considerable if you eschew new patient codes too often. For medical [...] - Reader Questions:
I&D Area Can Deflate 10060 Option
Question: Our physician performed a level-four E/M service in the emergency department for a patient [...] - Reader Questions:
Assess Multiple Procedures Across Multiple Spinal Levels
Question: During an operative session, my neurosurgeon performed the following procedures: L4"L5 diskectomy, L5"S1 diskectomy, [...] - Reader Questions:
Evaluate HPI Level to Narrow E/M Choice
Differentiate brief history of present illness from extended with these tips. Question: Our coding staff [...] - Physician Notes:
DOJ Arrests 94 People in One Day for Medicare Fraud Totaling Over $250 Million in Alleged False Billing
Plus: OIG Estimates $137 Million In KX Overpayments For DME. When the Medicare Fraud Strike [...] - Industry News:
Medicare Won't Pay Unless Patient Stays In Hospital For At Least 3 Days
Outdated regulation covering nursing home stays still applies. Medicare rules can at times be very [...]
