The Pulse

NCCI Edit Reversal Good News for Spine Surgeons!
Spine surgeons had been disappointed to read the April 2006 NCCI edit - Version 12.1 --- which bundled 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace, single interspace; lumbar) into 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar).

After intervention by key national societies, NCCI and CMS agreed to reverse the edits, effective October 1, 2006 and retroactive to April 1, 2006.

The October NCCI -- Version 12.3 -- now allows simultaneous billing of the two codes. Therefore, you will not need to append any modifiers to your claim if you bill 22630 and 22612 together, unless your payer requires the 51 modifier to indicate multiple procedures. If so, append the 51 to 22630, as 22612 is the higher paying service.

If you have had any denials since April due to the previous bundling of this code pair, 22630 may now be resubmitted. Even if you opted not to bill the 22630 in the original submission due to the edit, you may now resubmit your claim with a copy of the operative notes, explaining that you are requesting payment for the interbody fusion, which you originally didn't bill due to the previous edit.

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