Wiki Modifier 51-I'm unsure if

[tmarugg]

I'm unsure if I'm posting this question in the correct place. But here is my situation...

Our patient has a Medicare replacement plan. Patient underwent 1. exploration of spinal fusion at C5-6 with removal of instrumentation including removal of the screws, plate, and interbody cage device at C5-6. 2. C6 corpectomy 3. Anterior cervical discectomy & decompression, c4-5, C5-6, & C6-7. 4. Insertion of interbody cage device at C6. 5. Insertion of structural allograft at C4-5. 6. Anterior cervical fusion using allograft at C4-5 & locally harvested autograft from C5 to C7. 7. Anterior cervical instrumentation from C4 to C7 using Medtronic Atlantis Elite anterior cervical plating system. 8. Neurophysiologic monitoring of somatosensory evoked potentials (SSEP) & electromyogram (EMG)

Claim to insurance looks like this:
63081
22554
22585
22851
22851-59
20931
22846
22830-51

We received payment from the patient's insurance. Now we are getting a refund request due to multiple procedures being billed but not being reduced in the original payment. When I called to ask for clarification I was told procedure codes 63081 & 22554 should be reduced by 50%. When I asked what they considered the primary procedures I was told 22851 & 22846.

Now here's my question.....can application (22851) & instrumentation (22846) be considered the primary procedure? My brain says No. If anything procedure code 22830-51 is the only code that should be reduced.

Just need some clarification on this.

Thanks in advance

 

[CodingKing]

I come up with

63081 as primary procedure as its the highest RVU of 51.45
22554 as secondary procedure (Add Modifier 51) since it has a lower RVU of 36.72
22846 is add on code so its modifier 51 exempt
22851 is add on code so its Modifier 51 exempt. I have the second one as Dupe since code description says Device(s)
22585 is add on code so its Modifier 51 exempt
22830-51 I have as incidental per NCCI
20931 I also have coming up as incidental per NCCI