Wiki Multiple levels of spinal fusion

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anicole76

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We are receiving denials from Medicare when reporting multiple levels of spinal fusions. Submitting the primary code then add on code X number of units was denied. We began billing the primary code, then add on code on separate lines X 1 unit with modifier -76 appended. We received payment initially and are now receiving intent to recoup letters from CMS due to incorrect reporting of multiple levels. We have attemped to bill on separate line items X1 unit with no modifier which have denied as duplicate charges. The number of units being billed does not exceed what is on the MUE table. We have reviewed every provider manual, Medicare claims processing manual and MUE manual in an attempt to locate specific payer guidelines and are unable to find anything that clearly states the required format for reporting. Recent calls have been made to Medicare and all they say is they aren't allowed to tell us anything. If you have experienced this or know where the billing format can be located in the CMS manual we would GREATLY appreciate any feedback. Thanks in advance!
 
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Hi

The 76 should be added like the example below if it was three levels. But also take in account the amount of units allowed on the procedures if more levels are performed.

22633
22634
22634-76

Four levels
22633
22634
22634-76
22634-76

If it was only two levels then the 76 will not be needed.
22633
22634
I hope this helps you!
 
I am not sure where you are located and who your Medicare contracted carrier is, but for the 15+ years that I coded Neurosurgical claims I never used a -76 for multilevel fusions.

I would check your carriers LCD's in comparison to the NCD's...

When coding multiple levels I code the primary code and then the additional level code, this represents 2 levels...and then any other levels would be coded with the addt'l level code -59 because it is at a different anatomical site as opposed to a repeat procedure as described in -76. I received very few denials for this format as long as the levels were substantiated in the dictation appropriately.

Hope this helps :)
 
Thank you all so much for responding. Sherrie, Cahaba GBA Birmingham is also our contractor. When we read this notice last year, we changed from modifier -59 to modifier -76. The claims were paid with modifier -76 but we are now receiving letters requesting refund for the additional levels due to incorrect coding. Have you received any denials or refund request for modifier -76?
 
No we haven't received any recoup or denials. Make sure your not using more than one unit per line item. Our neurosurgeons perform a lot of complex fusions and they pay us appropriately. How many levels were you billing for?
 
We were billing four total, and they were submitted like this:
22612 X1 unit
22614 X1 unit
22614 -76 X1 unit
22614 -76 X1 unit

The claim was billed in and paid January 2014 and we just received the request for recoupment last week. We have billed additional levels in this format since receiving the update regarding use of modifier 59/76 in June of 2013. We have been reimbursed and had no problems submitting this way until a few weeks ago when the request for recoup letters starting coming in.
 
I would call medicare to make sure the units haven't been exceeded for that code 22614, in which I doubt. But they still count units even though we bill it out that way. If they don't send it back to claims department that way then I would go ahead and appeal with medical records. But I've never had where they paid it and then came back to recoup. Medicare has which isn't often at all deny one of the lines........but once I called Medicare customer service they have sent it back for reprocessing once they check the units for that code.
 
We have the same problem with Cahaba in TN. We get told we have exceed the number of 22614 they will pay when we bill extremely large fusions. Cahaba has given us problems with all add on codes for almost 4 years.
 
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