We have now had ADR approved twice, but Rush Copley Hospital is giving us trouble. In March, my husbands WC approved ADR using the 22851 code that the Dr. Geisler's office sent in. Then the AMA released a 0091T code, and the dr's office wouldn't schedule surgery until WC approved ADR using that new code. After much fighting, we know that it's not a possibility until this new code is in the 2006 code book(end of the year). So then I find out that another patient at our pain doc's office got approved with BCBS using 64999, with a doctor Stadlan at Chicago Neuroscience Center. I called BCBS of Illinois and they said, yes they "authorize" that code, but all billing is subject to review for payment. Meaning, they could decide to refuse to pay. I called this doctor's office to see about scheduling an appointment, and was told that they were scheduling surgeries using this code, but that BCBS isn't paying them so it seems this will soon come to an end. I hope that other patients get's his/her surgery. Besides, this Stadlan isn't experienced operating on the level that my husband needs: L2/3.
My husband is about to give up and get a fusion at that level. WC has made him go back to work(we are in the process of fighting that) 20 hrs/week, and paying him half his wages. He's lucky if he gets 15 hrs a week, due to the pain(oh, can't use PAIN as a reason for not working according to Fed WC).
Robin