Wiki Please help cpt codes 63042 and 22633

[0913@70]

I need help on this. Please.

Can you bill cpt code 22633 and 63042 for the same spinal level.per encoder pro it is not inlcuded, but discectomy or laminectomy is included in 22633.

If the pt had interbody fusion, revision decompressive laminectomy, discectomy, facetectomy and foraminotomy at l3-l4 level would you bill
63042 and 22633.51

thank you so much

 

[afeaster72]

We bill our laminectomy codes with a 59 modiier and we usually end up sending a letter pointing out that the fusion was done for spondylothesis and the lami done for spinal stenosis and not to prepare the interspace

 

[0913@70]

I would not put 59 modifier for the same level since it is a same incission, but I see your point regarding the diagnosis.

Thanks

 

[BradSW]

You don't need modifier 59 to bill 63042 with 22633, and yes you should bill it for a revision if that is the appropriate code per documentation. If your insurance denies anyhow, explain that it doesn't bundle per CCI and that it was for decompression of stenosis not just to prepare the interspace. I've never received a denial though so you should be fine.

 

[CHARLENA79]

22633 and 63042

I have a 2012 surgery that denied 63042-59 bundling with 22633. I sent notes with reconsideration and insurance paid...However, they are now taking their money back. Any suggestions?

 

[0913@70]

Thank you so much for all your information.