- Donald Liss, MD
Vice President Clinical Operations and Chief
Medical Officer
Horizon Blue Cross Blue Shield of New Jersey
3 Penn Place, East
Newark, New Jersey 07105 - Eric Berman, MD
Executive Medical Director
Horizon Blue Cross Blue Shield of New Jersey
3 Penn Place, East
Newark, New Jersey 07105
Via email: don_liss@horizonblue.com
SUBJECT: Horizon Blue Cross Blue Shield of New Jersey Distinct Procedural Service Modifiers (59, XE, XP, XS, XU) Medical Policy Number 0016 “Back Pain – Invasive Procedures”
Dear Drs. Liss and Berman:
On behalf of the American Association of Neurological Surgeons (AANS), the Congress of Neurological Surgeons (CNS) and the AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves (DSPN), we write to express our concerns regarding the Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) policy, Distinct Procedural Service Modifiers (59, XE, XP, XS, XU).
We are particularly concerned with the denial of CPT® code 63047 reported with appropriate modifiers (CPT code 63047 – 59-51) when lumbar decompression is performed at a different level in the same surgery with an interbody fusion (CPT code 22633), which is discordant with the 2022 National Correct Coding Initiative (NCCI) edit instructions addressing the use of modifiers with these codes. For example, when an L3-4 decompression (CPT code 63047) is performed for lumbar stenosis in an operative session at which an L4-5 decompression and fusion was performed for the management of spondylolisthesis with lumbar stenosis (CPT codes 22633 and 63052), both the decompression at L3-4 and the decompression and fusion at L4-5 should be reimbursed, as they represent additional work performed by the surgeon at a separate interspace.
Click here to view the full Neurosurgery Urges BCBS of New Jersey to Update Lumbar Spine Policy.
