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Nicole Posted Tue 21st of November, 2017 14:48:45 PM
We have recently (Since October) been getting rejections from Medicare when billing for a Kyphoplasty (22513) in an office setting. The LCD policy has not been changes. When we called Medicare they told us it is an "Internal guideline with Medicare that can't be released". Does anyone have any information they can share on this? Medicare is not being helpful, only telling us we need to do a re determination. Medicare has always paid for these before.
SuperCoder Answered Wed 22nd of November, 2017 08:50:04 AM

Hi Nicole,

Sometime there are system denials, which are due to either lack of modifiers or wrong modifiers been applied with codes. for example. This code is for unilateral or bilateral, so modifier 50 is not appropriate. You may check with you documentation and also send us some more details to reach for further conclusion. Thank you.

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