Leorah Posted Wed 03rd of June, 2020 06:36:44 AM
Our Dr.'s performed a multilevel kyphoplasty of T8-T9 and L1. I coded CPT code 22513 and 22515 with a 59 modifier. I used an ICD- 10 code of M80.08XA and M54.5. These codes were denied. Could you please tell me the possible ICD 10 codes that are appropriate for CPT codes 22513 and 22515. I previously tried submitting M54.14 per the suggestion from crosswalk on supercoder, but that ICD 10 denied as well. Thank you for your help
SuperCoder Answered Thu 04th of June, 2020 07:51:48 AM
You should code CPT code 22513 for the performed procedures.
CPT code 22513 is for percutaneous vertebral augmentation performed at Thoracic level
CPT code 22514 is for percutaneous vertebral augmentation performed at Lumbar level
Please note CPT code 22514 is getting bundled in CPT code 22513. Therefore, you would be able to bill CPT code 22513 only for the performed procedure. Unfortunately modifier is not allowed to override the bundling edit. Therefore, as per the latest NCCI guidelines, CPT code 22514 cannot be billed with CPT code 22513.
Also, please check your documentation to identify the exact ICD-10 CM codes. Please refer to the pre-operative and post-operative diagnosis details mentioned in your operative note.
There are a lot of ICD-10 CM codes that can be mapped with these procedures and it would not be feseable for us to share all with you. Please choose the appropriate dx basis your documentation.
If this information is not helpful, you can send us EOB (Explanation of benefit) document. This would help us identify the exact reason of denial.
Kindly share document on email@example.com
Reference: Ask an Expert Documentation.
Leorah Posted Sat 06th of June, 2020 23:49:28 PM
I coded CPT code 22513 which is at a thoracic level and 22515 not 22514. CPT code 22515 is an additional thoracic imaging. Please help me witht he ICD 10 codes and what is acceptable.
SuperCoder Answered Mon 08th of June, 2020 05:46:09 AM
Thank you for following up.
Please share EOB document related to this claim with us. EOB document would help us identify the exact reason for denial. There can be multiple reasons for claim denial like appending incorrect procedure code, incorrect diagnosis code, incorrect place of service, incorrect modifier or many other reasons. We want to make sure you bill the appropriate codes as per your documentation. Therefore, request you to forward the EOB document on firstname.lastname@example.org
Once we review the EOB, we will let you know whether your claim is being denied for incorrect diagnosis or for some other reason. We will try to fix all the concerns related to this claim.
With respect to appropriate ICD-10 CM codes that can be billed with this claim, there are multiple ICD-10 CM codes that can be billed for Percutaneous vertebral augmentation and we need to identify the appropriate code on basis of documentation. If you can provide us with the pre-operative and post-operative diagnosis as mentioned in your report, we would be able to provide you with the most appropriate diagnosis code(s).
Leorah Posted Thu 11th of June, 2020 05:13:38 AM
Thank you . I faxed the documentation. How long should does it generally take for a response?
SuperCoder Answered Fri 12th of June, 2020 09:12:45 AM
As per the submitted EOB, your claim has been denied due to below mentioned reasons:
CPT code 22513 – Your payer has assigned reason code 50 to this code which means: These are non-covered services because this is not deemed a 'medical necessity' by the payer.
CPT code 22515-59 - Your payer has assigned reason code 107 to this code which means: The related or qualifying claim/service was not identified on this claim.
Submitted medical record indicates pre-operative and post-operative diagnosis as low back pain for which Percutaneous vertebral augmentation (kyphoplasty) was performed. It seems your payer does not consider low back pain as an appropriate diagnosis for undergoing kyphoplasty procedure. It seems you need to mention the most appropriate and definite diagnosis in your medical documentation for which kyphoplasty was performed like fracture or osteoporosis at the mentioned levels. Low back pain would not be considered an appropriate condition for performing the procedure. Appropriate and definitive diagnosis should be mentioned in the medical record.
Your payer is questioning the “medical necessity” for performing the procedure. Hence kindly get in touch with your payer to identify if low back pain can be considered as a medically appropriate diagnosis for Kyphoplasty.
Leorah Posted Mon 15th of June, 2020 05:49:20 AM
Per the doctor I coded an M80.08XA which is Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture.
Could you please tell me the possible ICD 10 codes that are appropriate for CPT codes 22513 and 22515?
SuperCoder Answered Tue 16th of June, 2020 03:42:14 AM
Hi Leorah nbsp Please find below the most appropriate billable ICD- CM codes nbsp Appropriate ICD-CM codes for CPT code nbsp M M M M M M M M M M M M M M M M M M M M XA M XG M XA M XG M M...