I'm looking for opinions on whether my argument is correct and if anyone has seen this as well. No other BCBS in any of my other states have this edit and I am unable to find the policy.
Denial- X-ray of cervical, thoracic, and lumbar are denied as not paid separately. None of the codes are paid. We are being asked to use the entire spine x-rays.
Codes: 72040 for cervical, 72070 for thoracic, 72100 for lumbar. Requesting I use 72081-72084.
My argument- No cci edits and 72081-72081 are done with a different technique that not all machines can do. The 72081-72084 series is when the full spine is imaged on one film or a stitching software is used to line up the images to look at the full spine together.
BCBS response from medical director-
All of the claims were denied because the provider billed 72040, 72070 and 72100 together. 72100 (Radiologic examination, spine, lumbosacral; 2 or 3 views), was denied because it was billed on the same date of service as the denied procedures 72040 (Radiologic examination, spine, cervical; 2 or 3 views) and 72070 (Radiologic examination, spine; thoracic, 2 views), per our policy. A radiological exam of the entire spine includes a radiological exam of the cervical spine, of the thoracic spine and of the lumbosacral spine. Therefore, when these procedures are performed together, they should not be billed separately.
We reviewed this edit as well as a medical director with coding expertise took a look and believe the edit to be correct. Rather than reporting out each individual spinal x-ray (unbundling), the more comprehensive code which represents x-rays of all the anatomical sites of the spine and the total number of views is coding to the highest level of specificity. (72081-72084).
Denial- X-ray of cervical, thoracic, and lumbar are denied as not paid separately. None of the codes are paid. We are being asked to use the entire spine x-rays.
Codes: 72040 for cervical, 72070 for thoracic, 72100 for lumbar. Requesting I use 72081-72084.
My argument- No cci edits and 72081-72081 are done with a different technique that not all machines can do. The 72081-72084 series is when the full spine is imaged on one film or a stitching software is used to line up the images to look at the full spine together.
BCBS response from medical director-
All of the claims were denied because the provider billed 72040, 72070 and 72100 together. 72100 (Radiologic examination, spine, lumbosacral; 2 or 3 views), was denied because it was billed on the same date of service as the denied procedures 72040 (Radiologic examination, spine, cervical; 2 or 3 views) and 72070 (Radiologic examination, spine; thoracic, 2 views), per our policy. A radiological exam of the entire spine includes a radiological exam of the cervical spine, of the thoracic spine and of the lumbosacral spine. Therefore, when these procedures are performed together, they should not be billed separately.
We reviewed this edit as well as a medical director with coding expertise took a look and believe the edit to be correct. Rather than reporting out each individual spinal x-ray (unbundling), the more comprehensive code which represents x-rays of all the anatomical sites of the spine and the total number of views is coding to the highest level of specificity. (72081-72084).