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PLIF

Terri Posted Tue 11th of December, 2018 15:10:25 PM
Billing BCBS we have hit numerous CCI edits using 63047, 22612, 22633, 22840, 22853, 20936, 20931, 38222, 63709, 77003, 95937 x 4, 95861, 95925, 95926. DX M51.26 , DX G96.11
SuperCoder Answered Wed 12th of December, 2018 08:21:51 AM

Kindly explain your question in detail and also send the details of your report if you are looking for CCI edit. As there are number of codes mentioned above that may not be allowed even after using modifier. Thank you.

Terri Posted Mon 18th of March, 2019 08:11:52 AM
our provider would like us to bill the codes listed above .it is a bcbs of mi and he and a neurosurgeon did the procedure. we need clarification as when we are trying to explain codes that are allowed . can you please verify which codes are allowed and where modifier 62 is allowed as well. he believes he can use them all and edits are not an issue . he believes he should get reimbursed for these codes as he did 2 level cervical fusion .please advise with the cci edits what is consider bundling. thankyou
SuperCoder Answered Tue 19th of March, 2019 08:52:39 AM

Hi Terri,

Our team is working on your query, will get back to you soon.

SuperCoder Answered Wed 20th of March, 2019 09:23:29 AM


 

Hi Terri,

With the limited documentation provided above, and as per our understanding CPT code 22612 and CPT 22633 will not be billed together. Also, the codes 38222, 95861, 95925, 95926 will not be billed separately.

See the explanation below.

Code 63709 is a column 2 code for 63047, 22612, 22633, 22840, but a modifier is allowed in order to differentiate between the services provided.
Use modifier 59 with code 63709
CCI edit Rule:
Misuse of column two code with column one code

Code 63047 is a column 2 code for 22633, but a modifier is allowed in order to differentiate between the services provided.
Use modifier 59 with code 63047
CCI edit Rule:
Misuse of column two code with column one code

Code 22612 is a column 2 code for 22633, These codes cannot be billed together in any circumstances.

Code 22612 is bundled into code 22633 Code 22612 cannot be billed with 22633.
CCI edit Rule:
HCPCS/CPT procedure code definition

Code 38222 is column 2 code for multiple codes. These codes cannot be billed together in any circumstances. 

Code 95925 is column 2 code for multiple codes. These codes cannot be billed together in any circumstances.

Code 95926 is column 2 code for multiple codes. These codes cannot be billed together in any circumstances.

Code 95937 is column 2 code for multiple codes. These codes cannot be billed together in any circumstances.

Code 95861 is column 2 code for multiple codes. These codes cannot be billed together in any circumstances.

However, in the above documentation, there is mention of procedure PLIF (Posterior Lumbar Interbody Fusion), whereas, it also says “he did 2 level cervical fusion”. Kindly give the clarity on the same, as there will be change in set of codes from lumber to cervical. Feel free to ask for any further query. Thank you.

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