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Can we bill 63047 and 63048 with 63267?

Allison Posted Tue 08th of October, 2013 09:55:02 AM

Surgeon scheduled this surgery as 63047 and 63048 only, however when performed the surgeon decided to code as 63267 which is non covered under Florida Blue for an ASC. Please advise proper coding of this surgery. The surgeons office says we can't bill all three but in accordance with CCI edits it appears we can and possibly salvage some form of payment. 63267 76000 69990 were billed as of right now. See Below actual dictation

PREOPERATIVE DIAGNOSIS:
Right L4-5 synovial cyst with foraminal stenosis.

POSTOPERATIVE DIAGNOSIS:
Right L4-5 synovial cyst with foraminal stenosis.

OPERATION:
Right L4-5 hemilaminotomy and medial facetectomy, use of the operati ng microscope and use of
fluoroscopy.

PROCEDURE:
Under satisfactory general anesthesia, the patient placed in the prone position on the chest rolls
with the body properly cushioned. The back was prepped and draped and then using AP fluoroscopy,
the pedicle at L5 was identified. The skin was injected wit h 1% Xylocaine with a 9:1 ratio of bicarbonate and then a 1 inch incision made. The subcutaneous fat paraspinous muscles were reflected in a sharp and subperiosteal fashion and held in place with the Korosretractor. Again confirming the correct interspace with the AP fluoroscopy, then the microscope was in troduced into the field and then a number 3 and number 4 Kerrison were used to take down the yellow ligament in a sharp fashion.
There was a small nonunion of the medial portion of facet of the right inferi or L4 lamina that was "floating". This was removed, as it was not consistent with a spondylosis. Once the epidural
tat had been removed then a mass consistent with a large synovial cyst was taken down, peeling this away from the common dural sac and doing a foraminotomy from the pedicle superiorly and
inferiorly to ensure there were no further compressive defects. Being satisfied there were none, immaculate hemostasis was achieved using bipolar cautery. The wound was irrigated and then closed over Gel foam, soaked with 0.5% Marcaine, finishing the skin with subcuticular Vicryl sutures, followed by light dressing.
The patient was awakened and taken to the recovery room in satisfactory condition having tolerated the procedure well.

SuperCoder Answered Wed 09th of October, 2013 11:05:02 AM

Hi,

Please contact Manney at 866-228-9252 Extn : 4165

Thank You.

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