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May 11th, 2016 - atlspinebilling

22585 billed with primary code 22551

Our surgeon billed 22551, 22554-59, 22845, 22851, 22851, 22552, 22585, 20937 and 99222. The WC insurance company is stating that 22585 is not payable because it is included in 22551. Just wanted to check and see if 22585 is payable when billed with 22551 or if we are not to expect payment on that code.

Thank you.

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May 12th, 2016 - afgbilling 59 

re: 22585 billed with primary code 22551

Here is the info from my claim scrubber:

22554: Use precise alternative to modifier 59: You may want to report modifiers XE/XP/XS/XU replacing 59 in specific situations such as separate encounter, separate practitioner, separate site or unusual non-overlapping service. Modifier 59 should not be used when a more descriptive modifier is available. CMS will continue to recognize the modifier 59 in many instances but may selectively require a more specific -X(EPSU) modifier for billing certain codes at high risk for incorrect billing.

22552: CCI edit: 22552 is bundled into 22554. You may override the edit with a modifier (58, 59, 78, 79, 91, LT, RT, E1-E4, FA, F1-F9, TA, T1-T9, LC, LD, RC, LM, RI, XE, XP, XS, XU) on 22552 if circumstances and documentation support 22552 being distinct from 22554

22585: CCI edit: 22585 is bundled into 22551. You may override the edit with a modifier (58, 59, 78, 79, 91, LT, RT, E1-E4, FA, F1-F9, TA, T1-T9, LC, LD, RC, LM, RI, XE, XP, XS, XU) on 22585 if circumstances and documentation support 22585 being distinct from 22551

99222: Use modifier 57 if 99222 represents a significant and separately identifiable E/M service above and beyond the usual preoperative and postoperative care associated with 22551
Use modifier 57 if 99222 represents a significant and separately identifiable E/M service above and beyond the usual preoperative and postoperative care associated with 22554
Modifier 25 or 57 required for same day E/M service

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May 12th, 2016 - LBAROGIANIS 250 

re: 22585 billed with primary code 22551

How many levels are you billing? We never bill CPT® 22551 and 22554 together and CPT® 22585 is for the next level, not the primary level.

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