Wiki Medicare Reimbursement for Kyphoplasty code 22514

[debbie.denson74]

Our practice has had an issue lately with getting our kyphoplasty (22514) surgeries paid through Medicare. They are getting denied based on medical necessity. We used correct supporting ICD-10 codes but we cannot seem to get Medicare to pay for these surgeries. According to the LCD, this surgery should be covered. Here is an example of what we billed:

22514 - S32.010A

We have appealed all of these surgeries with no luck. Is anyone else having issues with this code? Please advise.

Thank you,
DD

 

[dferree37]

DD,

I am curious what your appeal denials are telling you.

 

[Davieda Skobel]

Help with Kyphoplasty coding.CPT 22514

The coding for Fractures has become very complicated in the last year or two and trying to make sense of what they want on the billing end is frustrating!
I believe what the insurance company is looking for is another diagnosis code. Ask your physician and check his documentation for a second diagnosis such as osteoporosis or osteoarthritis or complication from a medication. if you check the coding books, I have an Optum360, you will note that the diagnosis you are using has a MCC, CC notation which means it is a comorbity diagnosis. Try billing with the reason he has a compression fracture not just the compression fracture.Let us know if it works.
Good Luck!
I am pretty sure it will work.
Davie

Coding books, medical coding books