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CPT coding for fusion

Jessica Posted Wed 25th of February, 2015 11:03:13 AM

The following CPT codes are correct, 22612,22842,22614,63056,20930.
My supervisor tells me the CPT 63056 is the primary procedure however I believe it is CPT 22612. Which code is the correct primary procedure code & please give the rationale.
thank you

SuperCoder Answered Thu 26th of February, 2015 08:54:24 AM

Hi Sue,
Thank you for the query.
Procedure code with the highest CMS-based Relative Value Unit will be considered the primary procedure. CPT code 22612 is the primary procedure with the highest CMS RVU (Relative value unit) of 46.30 and CPT code 63056 is the secondary code with CMS RVU of 43.42.

Hope this information helps!

Jessica Posted Thu 26th of February, 2015 10:38:03 AM

Thank you!

Jessica Posted Thu 26th of February, 2015 10:54:51 AM

Was 22612 the higher RVU in 2014 than 63056?

SuperCoder Answered Fri 27th of February, 2015 07:11:46 AM

Hi Sue,

Yes, CPT code 22612 was having higher RUV than CPT code 63056 in 2014 (for all 4 quarters in a year).
Therefore, CPT code 22612 should be billed as the primary procedure.


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