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PLIF & tranpedicular decompression.

Anna Posted Mon 18th of April, 2011 19:28:47 PM

Is anyone else getting insurance denials when the surgeon does a transpedicular decompression for stenosis (63056) and a PLIF (22630). We are getting denials that 63056 is inclusive to 22630. However our surgeons are very clear in their documentation that they are decompressing the nerve root, not just preparing the interspace for the cage. We've sent notes with no luck. Any ideas on sources that might help with us appeal this denial?

Thanks! Anna

SuperCoder Answered Tue 19th of April, 2011 19:15:40 PM

In arthrodesis, cpt 22630 is to preapre interspace other than decompression, while cpt 63056 is the decompression of spinal cord. So, it is always possible to code both, and modifier with 63056.

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