Wiki HELP!!! Cannot Get 22845-59 To Pay!!!!

[caromissunc1]

I have been having a real problem getting specific claims paid with Medicare. I have coded 22845 & 22845-59 on 2 separate OP notes. MCR has denied them due to MUE guidelines. I have sent out a 1st and 2nd level appeal was well as an appeal to a qualified independent contractor. They all say that Medicare will only pay for 1 unit of 22845 per day. Whenever a fusion is done at C3-4, skip C4-5 and fuse at C5-6 & C6-7, is it appropriate to report 22846? I don't think it is because of the details underneath the SPINAL INSTRUMENTATION guidelines on page 118 in the CPT book. Any ideas? I hate to just write this off. Any help would be greatly appreciated.

 

[Amy Pritchett]

Please disregard my previous message. I incorrectly replied to the wrong thread.

 

[KristieStokesCPC]

The way I am reading (unless I am reading it incorrectly) this is that your physician placed the instrumentation over 3 segments total, which would code only to 22845. Medicare is correct in their denial due to the MUE's equaling 1. I know this probably isn't the answer you were looking for though .

Here is a really good article from Supercoder: https://www.supercoder.com/coding-n...instrumentation-claims-success-135757-article

 

[sarab86]

I am having the same problem. We actually have an exact case explained in the AANS guideline that indicates for a Non-adjacent two level fusion to bill instrumentation as 22845, and 22845-59. I have done this and cited the AANS in my appeals and am still getting the same denial. Im interested to see what other way I can try to get this paid.