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Kyphoplasty

Lindye Posted Thu 08th of October, 2015 18:02:01 PM

My doc did a kypho and used diagnosis S22.060G. I checked the Novitas LCD and according to them ,this is not a valid diagnosis. S22.060A for initial encounter is on the LCD. My doc coded it as S22.060G as subsequent encounter for delayed healing as we have seen patient in the office for this before. I am confused as to why this diagnosis is not covered by LCD. Is Medicare meaning this is initial encounter due to having kyphopasty, even though we have been treating this prior to kypho?
Thanks

SuperCoder Answered Fri 09th of October, 2015 04:03:01 AM

Well, for Novitas LCD policy no. L35130, L35434 & L34974, being checked. LCD policies are covered for the procedures coverage, that is the reason only initial encounter is covered. Because, LCD policies are checked through procedures with covered diagnosis. Hope it helps!

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