Wednesday, February 2, 2011

New procedure code 22551 - 29916 , 11045 - 11040


Musculoskeletal System – 5 New Codes

22551 - ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2
22552 - ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC
29914 - ARTHROSCOPY HIP W/FEMOROPLASTY
29915 - ARTHROSCOPY HIP W/ACETABULOPLASTY
29916 - ARTHROSCOPY HIP W/LABRAL REPAIR

PROCEDURE CODE AND DESCRIPTION

22551-  Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2- average fee payment - $2000 -$2200

Disputed procedure code 22551 - Reason

The services in dispute were reduced/denied by the respondent with the following reason codes:

*  MX59-Per NCCI, the procedure code is denied, as included in a more extensive procedure. Procedure included in 63081.

*  MX59-Per NCCI, the procedure code is denied, as included in a more extensive procedure. Procedure included in 22551.

*  U058-Procedure code should not be billed without appropriate primary procedure.

*  B291-This is a bundled or non covered procedure based on Medicare guidelines; no separate payment allowed.

*  X170-Pre-authorization was required, but not requested for this service per DWC rule 134.600.

*  X901-Documentation does not support level of service billed.

*  X193-Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly.

Issues

1. Is the allowance of procedure  code 22551 included in the allowance of another service/procedure billed on the disputed date of service?

Findings

1. According to the explanation of the respondent denied reimbursement for procedure  code 22551 based upon reason code “MX59.”

On the disputed date of service, the requestor billed codes 22551, 20937, 22326-59, 22554, 22585, 22851-59, 22845, 63081, 63082, 20930, 20926, 22855-22, and 22830-59.

Texas Administrative Code §134.203(a)(5) states “Medicare payment policies” when used in this section, shall mean reimbursement methodologies, models, and values or weights including its coding, billing, and reporting payment policies as set forth in the Centers for Medicare and Medicaid Services (CMS) payment policies specific to Medicare.”

Texas Administrative Code §134.203(b)(1) states “For coding, billing, reporting, and reimbursement of professional medical services, Texas workers' compensation system participants shall apply the following: (1) Medicare payment policies, including its coding; billing; correct coding initiatives (CCI) edits; modifiers; bonus payments for health professional shortage areas (HPSAs) and physician scarcity areas (PSAs); and other payment policies in effect on the date a service is provided with any additions or exceptions in the rules.”

Per CCI edits, procedure  code 22551 is a component of 63081; however, a modifier is allowed to differentiate the service. A review of the submitted medical bill finds that the requestor did not append a modifier to code 22551; therefore, the respondent’s denial based upon reason code “MX59” is supported.

Code 20937 is an “add-on” code that describes additional services related to code 22551. Because the requestor did not support billing the primary code 22551 as stated above in number 1, the ‘add-on” code is also not supported.

Per CCI edits, procedure  code 22554 is a component of 22551; however, a modifier is allowed to differentiate the service. A review of the submitted medical bill finds that the requestor did not append a modifier to code 22554; therefore, the respondent’s denial based upon reason code “B291” is supported

Per CCI edits, procedure  code 22585 is a component of 22551; however, a modifier is allowed to differentiate the service. A review of the submitted medical bill finds that the requestor did not append a modifier to code 22585; therefore, the respondent’s denial based upon reason code “B291” is supported.

Code 20930 is an “add-on” code that describes additional services related to code 22551. Because the requestor did not support billing the primary code 22551 as stated above in number 1, the ‘add-on” code is also not supported. In addition, per CMS guidelines, code 20930 is a status “B-Bundled” code; therefore, it is a packaged service. As a result, separate reimbursement is not recommended.





Respiratory System – 4 New Codes

31295 - NSL/SINUS NDSC SURG W/DILAT MAXILLARY SINUS
31296 - NSL/SINUS NDSC SURG W/DILAT FRONTAL SINUS
31297 - NSL/SINUS NDSC SURG W/DILAT SPHENOID SINUS
31634 - BRONCHOSCOPY BALLOON OCCLUSION

New Procedure codes (Add-on Codes)

11045 - Debridement Subcutaneous Tissue, each additional 20 sq cm
11046 - Debridement Muscle/Fascia, each additional 20 sq cm
11047 - Debridement Bone, each additional 20 sq cm

Deleted codes

11040 & 11041 Debridement; skin; partial & full thickness

1 comment:

  1. Having within the coming years it will have a new move through the regular ICD-9 unique codes to the ICD 10 Codes Search. That alter had been initially planning to come about simply by April involving 2014 nevertheless, it can be currently seeking like the very first that alter will need location can be April involving 2015.

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