Email to a colleague
View Printer Friendly           Home | Legislative Activities

Spinal Fusion Medicare Coding Edit Deleted On July 26, 2006, the AANS was notified that the Centers for Medicare and Medicaid Services (CMS) would delete a coding edit that prohibits the reporting of CPT code 22612, arthrodesis, posterior or posterolateral technique single level; lumbar (with or without transverse technique) and CPT code 22630 arthrodesis, posterior interbody technique , including laminectomy and/or diskectomy to prepare interspace (other than for decompression), single interspace; lumbar together for the same lumbar level. The reversal takes effect October 1, 2006 and came in response to a letter sent by AANS, CNS, North American Spine Society (NASS) and the American Academy of Orthopaedic Surgeons (AAOS) objecting to the edit. In the letter, the specialty societies made a strong case that the two arthrodesis procedures are distinct and separately identifiable, and as such, should remain separately reportable with the appropriate modifier, even when performed at the same lumbar level. The deletion of the edit is retroactive to its implementation date of April 1, 2006. Physicians who have had claims denied for CPT code 22630 because it has been reported with CPT code 22612 between April 1 and October 1, 2006, may submit the claims for re-adjudication to their local Medicare carrier after October 1, 2006. For more information contact Cathy Hill in the AANS/CNS Washington Office at chill@neurosurgery.org.