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Spinal surgery denied code

Diane Posted Wed 08th of April, 2015 12:40:39 PM

Procedure: Spinal Laminectomy L5 Bilateral, Laminectomy S1 bilateral, Repair durotomy, Forminotomies bilaterally L5-S1, Pedical Screw Fixation L5 to the sacrum, Partial discectomy L5-S1 on right, application of Dura Gen dural matrix graft and posterolateral fusion with DBM croutons. I coded 22612,63047,63707-59,22842 20930. Humana Medicare paid all codes except 22842 pedicle screw fixation, 20930 bone graft and 63707-59 dural repair. I would like to file an appeal but need to know if I coded correctly and if so what documentation can I supply to support my appeal.

SuperCoder Answered Thu 09th of April, 2015 08:02:58 AM

Please find below the codewise description:

CPT code 63707: If the dural injury occurs during the operative laminectomy, CCI bundles the dural repair with the laminectomy procedure. Surgeon performed a lumbar laminectomy, facetectomy and foraminotomy, and during this procedure there was a dural tear that created a fluid leak and the surgeon subsequently repaired the dural injury, you only report 63047. You do not report 63707.

CPT code 22842: This code is for posterior segmental instrumentation, 3 to 6 vertebral segments. In your case, instrumentation was performed on L5-S1. You should report this with CPT code 22840.

CPT code 20930: Correct coding. You can bill this code for application of Dura Gen dural matrix graft.

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