Wiki PLIF denials

[sdunaway1]

I have recently received 3 denials for the 63047 bundling into 22633. I am in Idaho and the payors are Blue Cross , Blue shield and Bridgespan. Has anyone else had this issue ? We have always been reimbursed for both main CPT codes in the past , even with Medicare.

Any information would be appreciated!

Thank you ,

Stephanie

 

[mschaller]

Medicare stopped paying these codes together a couple years ago. We were originally billing them to Medicare even though we were getting denials as the AANS was working to try to get Medicare to overturn their decision. The problem was we would get denied for 63047 and they would pay 63048. Then we would have to refund the payment for 63048. Until recently we have been being paid by commercial insurance however I noticed Aetna has stopped paying it. I am assuming most insurances will be following suit.

 

[Dalake5]

if its done at different level, you have to use -59 on 63047,if not it will bundle.

 

[mschaller]

The May issue of CPT Assistant makes a correction to a recent article saying that 22630 or 22633 and 63047 at the same level could not be billed together. They are going back to their previous advise that they may be reported together when additional work is required to complete a decompression. I would use this article in my appeal as AMA guidelines are a general rule. This will most likely still not be paid by Medicare payors but with this new article I think its definitely worth a fight on commercial payors.

 

[sdunaway1]

thank you for your information. I will add this document to the appeals.