Neurosurgery Coding Alert

Question: The insurance company is asking for a refund on a claim with an October 1997 date of service. We billed for code 22554 for fusion and 61712 for microdissection. The insurance company claims that 61712 is mutually exclusive to 22554 and that an overpayment was made. Was this edit applicable to year 1997? If not, where can we get documentation to support our position?

Texas Subscriber

Answer: According to the guidelines in CPT 1997, 61712 should be used only with codes 61304-61711, 62010-62100, 63081-63308 and 63704-63710, says Kathy Zmuda, CPC, lead inpatient coder with CIGNA Healthcare in Peoria, Ariz.

Unfortunately, the insurance company is correct in asking for its money back. According to the defining language of code 22554 (arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace [other than for decompression]; cervical below C2), the scope is already in place. Billing 61712 with 22554 would be billing twice for the scope.

Please note that 61712 has been deleted and is not listed in CPT 2000.