Wiki Cpt code 22633 with 63047, 63048

[mdarling]

I have been billing spine surgeries for quite some time and work closely with the North American Spine Society. I have been getting denied codes 63047, 63048 when billed with 22633. I have been using the 59 modifier on 63047, 63048 if the operative note says decompression of neural elements was performed. The spine book mentions that Decompression 63047 is unlikely reportable unless there has been more laminectomy and neural element decompression is performed. Has anyone else had this issue? I don't bill 63047 and 63048 if the discectomy was performed to prepare the interspace; I only bill if its for documented decompression. Does anyone have any other feedback that I can send to the insurance companies to appeal?

 

[christinnagle]

hope this helps point you in a direction. Per The CMS CCI Manual, under chapter 4 CPT codes 20000-29999 "CMS payment policy does not allow separate payment for CPT codes 63042 (laminotomy...; lumbar) or 63047 (laminectomy...; lumbar) with CPT codes 22630 or 22633 (arthrodesis; lumbar) when performed at the same interspace. If the two procedures are performed at different interspaces, the two codes of an edit pair may be reported with modifier 59 appended to CPT code 63042 or 63047."

 

[CoderinJax]

payer side

I work for a private pay, and we do not allow the 22633/63047-59 combo unless the work is done on a level other than the arthrodesis. Our carrier clearly shows in our Payment Policies we follow NCCI edits. Also, there's a October (2016) CPT Assistant that reflects this same stance.
Hope this helps.