mhstrauss
True Blue
Can I get some input from any spine pro’s?
One of my surgeons performed a TLIF w/ decompression at L4-5 -- we billed 22633, 63052, and also L5-S1 Lam w/ facetectomy and PLF (no interbody work done at this level) – we billed 63047-59 and 22614.
This claim is from June 2022. Medicare is attempting a recoup, stating that the 63047 for L5-S1 should have been coded as 63053. The RAC letter references a CPT Assistant article from March 2022 (which we do not subscribe to, but I am going to request)
I do not agree with their reasoning. Notation in 2022 CPT book states that 63052, 63053 are to be used at the same level as interbody work. I believe that the RAC auditor is interpreting the CPT description to be that 63053 can be used for L5-S1 on this case just because interbody fusion was performed during the same case, albeit on a separate level.
Does anyone else interpret CPT’s guidance for 63053 the same way? Or even better, does anyone have access to the March 2022 CPT Assistant article that they’d be willing to share?
TIA!
One of my surgeons performed a TLIF w/ decompression at L4-5 -- we billed 22633, 63052, and also L5-S1 Lam w/ facetectomy and PLF (no interbody work done at this level) – we billed 63047-59 and 22614.
This claim is from June 2022. Medicare is attempting a recoup, stating that the 63047 for L5-S1 should have been coded as 63053. The RAC letter references a CPT Assistant article from March 2022 (which we do not subscribe to, but I am going to request)
I do not agree with their reasoning. Notation in 2022 CPT book states that 63052, 63053 are to be used at the same level as interbody work. I believe that the RAC auditor is interpreting the CPT description to be that 63053 can be used for L5-S1 on this case just because interbody fusion was performed during the same case, albeit on a separate level.
Does anyone else interpret CPT’s guidance for 63053 the same way? Or even better, does anyone have access to the March 2022 CPT Assistant article that they’d be willing to share?
TIA!