CPT codes?

[MikeC123]

Concerning disc replacement. My doctors office said the CPT code they would use for my insurance company is 22899(unlisted procedure). It was my understanding that they were suppose to use 0091T(Lumbar Artificial Disc Replacement), but the billing director said that insurance companies usually did not recognize t-codes. Does anyone know why this is? I was hoping that the procedure receiving a CPT code from the AMA would make it more likely to gain approval from insurance copanies and that is still my hope. Does anyone have any more information on this? What CPT codes were used for those of you who did receive approval from your insuarance companies?

Michael

[letteski]

Mike,

On my approval letter for ADR I have the following codes:

Procedure: 22851-Apply Spine Prosth Device
Planed Treatment: CPT 63090, 22851, 63091

Authorization is considered Medically Necessary based on diagnosis and information supplied to date. Hope this helps.

[Dale S]

Mike,
My declined procedures were the same as Paulette's. Good luck.
Dale

[Pat&Robin]

Mike,
Workers comp approved all the listed codes mentioned by Paulette, then the doctors office turned around and said that they needed 0091T approved, which hasn't been done to date. My understanding, from reading the AMA website and also a private email from AMA is that 0091T had to be used after July 1, and that 22851 could no longer be used. Who, may I ask, is your doctor?? If we could find a doctor/hospital willing to accept those billing codes, we would switch doctors immediately!
Robin

[anon]

Hello,

Just wanted to shed some light on these codes. Prior to July 1st, the codes that were used were 22899 (unlisted spinal procedure) or 64999 (unlisted nervous system procedure) with 22851. The 22851 represents the actual placement of the device, and has a relatively low reimbursement rate. 0091T was created to replace both the unlisted code and the 22851, and combines both the work involved and the placement of the device.

Unfortunately, the reason for the AMA creating what they call a "category III" code for the ADR is for research and tracking purposes. I spent some time on the phone with the AMA this morning, explaining the dilema that everyone is facing - there's an actual code of 0091T, but none of the insurance companies are recognizing it. I was told that it is up to the companies themselves to update their systems and review the info from the AMA website themselves. For anyone who has not read this info, please see the site below:

http://www.ama-assn.org/ama/pub/cate...885.html#0075T

I have also found that sending those pages from the AMA has helped (particularly with Workers Comp) to clarify the code for the insurance company.

I was also told that typically category III codes become full-fledged CPT codes at some point in time. The AMA will not release the latest list of "real" codes until November for 2006.

I find it very interesting that these are being coded as 63090. That code is for a vertebral corpectomy, which is the removal of part of the vertebrae and discs. As you all know, the ADR entails the removal of disc tissue, and is not the same as a 63090. In fact, I have seen the coding for an ADR patient who had both the ADR and a corpectomy at the same time, but they are not one and the same.

The good news is that there have been appeal denials overturned for the 0091T by Anthem BCBS, as well as private insurance companies and Workers Comp insurers.