22633 and laminectomy codes

Good morning! I am going round and round with one of my spine physicians. Do you allow your physicians to bill the laminectomy codes (63XXXX...most commonly 63047) with 22633 when done at the same level? The laminectomies are being done for decompression which is why my doctor insists they are billable together.

Thank you for your input!
Jodi

Comments

  • edited May 2017
    The 63047/22633 continues to be problematic for spine surgeons. The issue lies with the NCCI edits. CCI says only billable together if done at a different letter and NASS and CPT do not. Unfortunately, many commercial insurances now follow NCCI edits and will not pay unless the decompression is done at a separate level. BCBS has a corporate policy that automatically denies the two codes when billed together even with the modifier 59 used to indicate the separate level and you have to appeal. NASS has met with NCCI to try and have the edit reversed, but NCCI left the edit in place. There was a very good article in the June 2016 issue of Healthcare Business Monthly (AAPC) on this very issue.

    Sandi Hamrick, CPC
    Toledo Orthopaedic Surgeons
  • Thanks for responding Sandi! I forgot about the article in the AAPC magazine, I will pull that for reference.
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