Kirsten Posted Tue 10th of March, 2015 16:36:05 PM
The doctor performs a postero/lateral fusion at lumbar level L3-L5. In addition, he also performs a laminectomy for at L4 for central spinal decompression. I know that the CPT description for 22633 states that they are allowed if it is "other than for decompression". Is there a way to code these two together and get paid even though they are at the same level? If so, what modifier could you use since -59 has been broken down? Neither XE, XP, XS or XU seems to apply.
SuperCoder Answered Wed 11th of March, 2015 04:02:43 AM
List the codes separately in addition to code for primary procedure with the help of modifiers.
CMS faces multiple issues when dealing with claims reporting modifier 59 (Distinct procedural service). The agency solved these issues (as you mentioned) by 'X' modifiers that will replace modifier 59 in some instances for claims submitted to CMS. They are:
XE: Separate encounter (A service that is distinct because it occurred during a separate encounter).
XS: Separate structure (A service that is distinct because it was performed on a separate organ/structure).
XP: Separate practitioner (A service that is distinct because it was performed by a different practitioner).
XU: Unusual non-overlapping service (The use of a service that is distinct because it does not overlap usual components of the main service).
In your case it seems like procedure done by the same doctor, so you can choose between XE/XU according to procedure performed.
Hope it helps you.
Kirsten Posted Wed 11th of March, 2015 07:51:10 AM
Thank you for your response. Since it was the same encounter, will a laminectomy for central decompression at the same level as a postero/lateral fusion be paid with an XU modifier? Would this scenario be appropriate for use of the XU modifier?
SuperCoder Answered Thu 12th of March, 2015 02:23:51 AM
Since, different procedure done on the same site by the same provider, that can be billed by appending the appropriate modifier according to the procedure performed.
Here I am leaning towards XU modifier.
Hope it helps you.
Kirsten Posted Thu 12th of March, 2015 10:54:35 AM
I hate to beat a dead horse into the ground, but after my last post and before your response, I received an article in my email from Karen Zupko that cites the 2015 Orthopedic NCCI edit that states that they cannot be billed out together period; unless the central decompression is carried out at another level than the fusion. BCBS will not pay them together either based upon the NCCI edit. So with this information and now reading your response, I am completely confused. HELP!
SuperCoder Answered Fri 13th of March, 2015 06:33:31 AM
The coding combination for fusion and laminectomy has been a source of confusion for a long time and there is a new turn recently. As per NCCI edit, the 2 codes are having modifier indicator of 1 which means a modifier may allow billing of both codes together, however it is best not to bill the laminectomy to medicare. Hope this helps you.