Wiki 22845,59

[agreene169@gmail.com]

Ambetter Georgia is denying CPT 22845,59 when billed with 22551 22552 22853 we have appealed with notes which justify the code but can't get the code paid. Has anyone had any luck getting this code paid?

 

[christinnagle]

22845 and 22853 are NCCI bundled. So if 22853 was a "stand alone implant" it will include the internal hardware to attach that implant to the spine. It's pretty rare to put anterior plate OVER an anterior cervical interbody fusion. Do a google search for the name of the interbody implant & if the implant has ANY internal screws, etc that attach to the inner portion of the vertebral bone, then you need to confirm if the additional hardware is either the cover plate to access the implant's internal screws (then 22845 will not be billable) OR if 22845 supports a completely separate hardware attached to the outer portion of the spinal bone (but not part of the interbody hardware) then 22845 is billable (w/modifier) in addition to 22853. In my experience, when the latter is supported it needs -59 on both 22845 & 22853, but depends on the carrier, documentation, and implant used.

 

[melissaaos]

We have found we cannot bill 22853 with 22845 even with a 59 with the 22551 /anterior.
See page IV-9 in NCCI guidelines chap IV that may be helpful as well.