CPT updates their policy regarding nerve root decompressions and interbody fusions
AANS, NASS and AAOS have been working hard on getting CPT to change their previous October 2016 CPT Assistant regarding nerve root decompression 63047 and interbody fusion 22633 being inclusive. As of the May 2018 it appears that those specialty societies have accomplished CPT/AMA to change that policy. In the May 2018 issue they reversed their previous October 2016 Assistant stating:
“On further analysis of this issue, it was demonstrated that this recommendation was inconsistent with previously published CPT® Assistant advice, which is that codes 22633 and 63047 may be reported for the same interspace when additional work is required to complete a decompression at a single spinal level. It is also appropriate to report codes 22633 and 63047, if the two procedures are performed at different interspaces. Modifier 59, Distinct Procedural Service, should then be appended to indicate that these are two distinct procedures.
This correction aligns the coding advice with historical precedent published prior to the incorrect revisions in advice given in the October 2016 FAQ.”
However, this change does not appear to have affected Medicare’s opinion via the NCCI guidelines Chapter Four which states that they continue to feel that 63047/63042 are inclusive in 22630/22633 unless performed at a different interspace. Meaning that if they did nerve root decompressions of L2, L3, L4 and L5 and also did a PLIF (22630) or double fusion (22633) and L4/5 – you will only be able to report 63047-59 (L2 nerve root); 63048-59 (L3 nerve root) as the nerve root decompressions of L4 and L5 will continue to be bundled into the 22630/22633.
What this change does to is allow you to use it in an appeal with your private payers if they deny your reporting of 63047 and 63048s with 22633 when performed at the same levels. But keep in mind, if your contracted payers state that they follow NCCI guidelines and edits, they may still be able to deny reimbursement.
NASS and the other societies are still trying to work with Medicare/NCCI to over-turn this bundling but as of the updated 2nd quarter edits it is still there.