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Billing unlisted procedure

Susquehanna Valley Posted Thu 16th of May, 2019 08:18:01 AM
I am working on an interspinous process decompression and arthrodesis using Aileron spinal implants for levels L3-4 and L4-5. I am using codes 22612,22614, and 22899 unlisted. My question is can I bill the unlisted procedure 22899 twice during the same operative session? For example: 22899 and 22899-XS? (Medicare patient) Thank you!
SuperCoder Answered Fri 17th of May, 2019 04:56:06 AM

Hi,

As per CPT guidelines, the MUE for CPT 22899 is 1. So, you cannot bill CPT 22899 more than 1 unit.

 

Thanks

 

Susquehanna Valley Posted Fri 17th of May, 2019 09:51:58 AM
I didn't think so either, but needed to clear up some confusion.Thank you for your prompt answer!
SuperCoder Answered Mon 20th of May, 2019 10:43:10 AM

Hi,

 

There is no specific CPT code for Aileron spinal implants, hence the appropriate code to describe this procedure is 22899. You cannot bill CPT 22899 more than 1 unit. If you bill two units of 22899, then your claim will get deny. Implants for levels L3-4 and L4-5 will be consider inclusive in 22899.

 

When submitting an unlisted-procedure claim, your documentation should include the complete operative note and an explanatory cover letter.

 

Unlisted procedure codes do not appear in the Medicare Physician Fee Schedule, so they do not have assigned fees or global periods. Your payers will generally determine payment for unlisted-procedure claims based on the documentation you provide.

 

Any time you file a claim using an unlisted-procedure code, you should include a cover letter stating why you are using the unlisted code. This separate report should explain, in simple, straightforward language, exactly what the physician did.

 

Hope this helps.

 

Thanks

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