CMS Denials for CPT code 22633 and 63047

Question:

We reported CPT code 63047 with 22633 for a laminectomy, facetectomy, foraminotomy at the same level to Medicare. Both service were performed at L4-5 and well documented according to the CPT rules. We received a denial for CPT code 63047 as inclusive and have tried to appeal, but Medicare will not reverse the denial.

Answer:

Medicare, via the National Correct Coding Initiative (NCCI) edits, communicated that this code combination, when reported together for work at the same level during the same operative session by the same surgeon, will consider the services inclusive and will not allow payment for both services. Medicare considers the work of the laminectomy and decompression to overlap with the work that is valued into the interbody fusion. While CPT states the two are reportable when the work is over and beyond the work of the discectomy, CMS does not consider the work at the same level overlapping. Moving forward, do not report the 63047 with 22630 or 22633 to Medicare unless the work associated with the laminectomy as defined by CPT code 63047 is performed at a level independent of the interbody fusion (22630 and 22633).

*This response is based on the best information available as of 02/26/15.

Diagnostic Arthroscopy and Meniscectomy

Question:

Can I report a right meniscectomy and left diagnostic knee arthroscopy during the same session?

Answer:

Yes, CPT code 29881 (meniscectomy) and CPT code 29870 (diagnostic arthroscopy) are reportable during the same operative session when they are independently performed on different knees. Use of modifiers may be payor dependent. According to CPT rules, you would report 29881 and 29870-59. Some payors may want the RT/LT modifiers alone; some payors may want the RT/LT and the 59. In 2015, the “X” modifier for separate structure might be required.

*This response is based on the best information available as of 01/08/15.