Wiki 22551 and COB15 Denials

[jencarroll2010]

I bill for both the professional and ambulatory surgical center and I am have been getting COB15 denials for 22551, 22552x2, 22845, 22853 and 20936. No matter what I do and even if the professional components have processed for payment the facility claim will not get processed. What am I missing?

 

[malissaannj@yahoo.com]

One thing I see that could be the issue is you have to amend a modifier to the 22845-59 if using with 22853. There is guidance from CPT March 2017 and several other articles supporting that if it is a "stand alone" device you cannot code the "integral" instrumentation but if it is not, then you can. However, it will most likely get denied and you will have to appeal b/c it seems the NCCI edit upholds maintaining that edit even though spine surgeons have written and explained requesting the edit be removed. If you go that route and have to appeal you will need to be able to support the type of device in your appeal. Good luck!