There are two coding updates that I want to address that could potentially lead to additional revenue for your ASC claims. Now let me start by saying that many carrier policies may bundle or package these services into the primary procedure so it might take a little effort on your part by appealing any claims denials in order to achieve these payments.
First is CPT code 22830 for exploration of spinal fusion. Originally you could only report this code when the exploration took place at a different spinal level from which a new arthrodesis procedure is being performed. The current information now states that a spinal exploration “is not considered an integral part of an arthrodesisâ€, therefore when an arthrodesis is documented in the operative report and a spinal exploration is documented in the operative report you can code the appropriate arthrodesis code along with a spinal exploration code. However, CPT code 22830 does bundle into all of your arthrodesis codes so you will still have to navigate the NCCI Edit bundling issue.
There is a CPT Assistant article from Oct. 2016 which stated that 63047 (decompression of spinal stenosis) is included in the arthrodesis combination code 22633. I can tell you from personal experience that many carriers referred back to this specific article when denying 63047 as inclusive to 22633. After many discussions with the AMA who reached out to the numerous spine specialty societies it was determined that the historical precedence set prior Oct. 2016 would be the correct coding advice which allows 63047 to be reported in addition to 22633 and is also consistent with the guidelines published in the CPT manual. This new article can be found in CPT Assistant May 2018. My advice is to carefully review your EOB’s and when the carrier cites the Oct. 2016 coding advice as the reason for claims denial, appeal the claim and notify them that this information has changed. This change only applies to the AMA and the NCCI Edit Policy Manual still bundles 63047 into 22630 and 22633.