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Insurance Hell All insurance-related matters are here: Medicare, worker's compensation, appeals, denials, insights, wins, losses. PRICING is here too. Note: This forum has posts from 2006 forward. Older ones are in the Big File.


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  #1  
Old 05-19-2015, 11:13 AM
Cheryl0331 Cheryl0331 is offline
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Join Date: Dec 2010
Posts: 890
Default Insurance codes

Hello all, Thankfully Dr. Clavel provided me with the surgical note in English and I can do the currency exchange. I am uncertain about which codes to use:


22856 vs. 22858 Total disc arthro, anterior approach, including discectomy, end plate prep, removal of osteo for never and spinal cord decompression...


84.62 insertion of device


0090T one level cervical adr


0092T for each additional level

Input greatly appreciated. Thank you. Cheryl
__________________
54 yr old female 5'7" 147 lbs. non-smoker conservative treatments failed
2007 fusion @ C4-6 peek cages, failed due to long term use of cox-2 inhibitor
2008 revised C4-6 donor bone, plate & screws
2009 fusion with Roi-C @ C3-4
2015 MRI & CT mjr ddd @ C6-7, segmental kyphosis at C7-T1, 2-level M6-C prosthesis by Dr. Clavel Barcelona Spain
2019 H.O. formed behind M6-C @ C6-7 left nerve rt & in spinal canal.
2020 Revision C6-7 to a CP-ESP prosthesis by Dr. Schmitz Dusseldorf Germany
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  #2  
Old 06-09-2015, 05:04 PM
Cheryl0331 Cheryl0331 is offline
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Join Date: Dec 2010
Posts: 890
Default I sent my first claim today

I got the codes and packaged it all and sent it today. I will update as soon as I hear anything...
__________________
54 yr old female 5'7" 147 lbs. non-smoker conservative treatments failed
2007 fusion @ C4-6 peek cages, failed due to long term use of cox-2 inhibitor
2008 revised C4-6 donor bone, plate & screws
2009 fusion with Roi-C @ C3-4
2015 MRI & CT mjr ddd @ C6-7, segmental kyphosis at C7-T1, 2-level M6-C prosthesis by Dr. Clavel Barcelona Spain
2019 H.O. formed behind M6-C @ C6-7 left nerve rt & in spinal canal.
2020 Revision C6-7 to a CP-ESP prosthesis by Dr. Schmitz Dusseldorf Germany
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  #3  
Old 06-09-2015, 06:21 PM
Cheryl0331 Cheryl0331 is offline
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Join Date: Dec 2010
Posts: 890
Default CPT/ICD-9 codes as applicable

Additional comments or supporting documents *listed and attached
1. Letter of Conservative Treatments & Patient History
2. Medical Assessment, Treatment Plan & Medical Information regarding procedure
3. Procedural (Surgical) Notes & Diagnosis
4. Arrangements to pay for services: Funds obtained by loans: Bank wire confirmation
5. Itemized Statement in English
6. Euros to US Dollars Conversion

71020 chest x-ray
93000 Electrocardiogram, complete Routine ECG with at least 12 leads; with interpretation and report

V72.63 Pre-operative blood work-up
22856 Total disc arthroplasty (artificial disc), anterior approach, including discectomy with endplate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection), single interspace; cervical

22858 second level of cervical disc arthroplasty
__________________
54 yr old female 5'7" 147 lbs. non-smoker conservative treatments failed
2007 fusion @ C4-6 peek cages, failed due to long term use of cox-2 inhibitor
2008 revised C4-6 donor bone, plate & screws
2009 fusion with Roi-C @ C3-4
2015 MRI & CT mjr ddd @ C6-7, segmental kyphosis at C7-T1, 2-level M6-C prosthesis by Dr. Clavel Barcelona Spain
2019 H.O. formed behind M6-C @ C6-7 left nerve rt & in spinal canal.
2020 Revision C6-7 to a CP-ESP prosthesis by Dr. Schmitz Dusseldorf Germany
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  #4  
Old 06-09-2015, 06:25 PM
Cynlite's Avatar
Cynlite Cynlite is offline
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Join Date: Mar 2015
Posts: 666
Default

Thanks for starting this thread Cheryl. I doubt my insurance will cover any of my surgery but, I'm sure I'll try anyway. I sure hope you are successful!

Colorado Babe said that the trick is to appeal immediately after they reject you. Not sure why the timing is so important. Perhaps she will add her two cents when she reads your thread. She just kept calling and pushing her cause.
__________________
2006: epidural shots did nothing; 2 surgeons recommended 2 level fusion, I declined.
2007 - 2010 4 foraminotomy and cord decompression cervical surgeries and 2 endoscopic discectomy T7-T8 surgeries; total 6 with Dr. Jho (Pittsburgh,PA) My C6/C7 autofused around 2009.
2013 - 2015: epidurals 3 times (again did nothing) and 4 Radiofrequency ablation (or RFA) procedures.
2016 more RFAs, hit the 10 year mark of this insanity and pain, 3 level M6-C ADR with Dr. Clavel May 19, 2016
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  #5  
Old 06-09-2015, 06:54 PM
Cheryl0331 Cheryl0331 is offline
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Join Date: Dec 2010
Posts: 890
Default All we can do is ask

Quote:
Originally Posted by Cynlite View Post
Thanks for starting this thread Cheryl. I doubt my insurance will cover any of my surgery but, I'm sure I'll try anyway. I sure hope you are successful!

Colorado Babe said that the trick is to appeal immediately after they reject you. Not sure why the timing is so important. Perhaps she will add her two cents when she reads your thread. She just kept calling and pushing her cause.
The only thing I foresee needing later for an appeals process if denied reimbursement; would be documentation on the following:
1. Joint Commission Insurance accreditation for BSC and/or Hospital Quiron
2. ISO compliance
3. Statement showing that this procedure is the standard level of care in Spain and approved by your EMA
__________________
54 yr old female 5'7" 147 lbs. non-smoker conservative treatments failed
2007 fusion @ C4-6 peek cages, failed due to long term use of cox-2 inhibitor
2008 revised C4-6 donor bone, plate & screws
2009 fusion with Roi-C @ C3-4
2015 MRI & CT mjr ddd @ C6-7, segmental kyphosis at C7-T1, 2-level M6-C prosthesis by Dr. Clavel Barcelona Spain
2019 H.O. formed behind M6-C @ C6-7 left nerve rt & in spinal canal.
2020 Revision C6-7 to a CP-ESP prosthesis by Dr. Schmitz Dusseldorf Germany
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  #6  
Old 06-09-2015, 07:15 PM
Cynlite's Avatar
Cynlite Cynlite is offline
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Join Date: Mar 2015
Posts: 666
Default

Does your insurance say that it will cover surgery abroad?
__________________
2006: epidural shots did nothing; 2 surgeons recommended 2 level fusion, I declined.
2007 - 2010 4 foraminotomy and cord decompression cervical surgeries and 2 endoscopic discectomy T7-T8 surgeries; total 6 with Dr. Jho (Pittsburgh,PA) My C6/C7 autofused around 2009.
2013 - 2015: epidurals 3 times (again did nothing) and 4 Radiofrequency ablation (or RFA) procedures.
2016 more RFAs, hit the 10 year mark of this insanity and pain, 3 level M6-C ADR with Dr. Clavel May 19, 2016
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  #7  
Old 06-10-2015, 08:59 AM
Cheryl0331 Cheryl0331 is offline
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Join Date: Dec 2010
Posts: 890
Default yes

50% of out of network. But I am sure they will have some stipulation on the when and why and how they cover it...
__________________
54 yr old female 5'7" 147 lbs. non-smoker conservative treatments failed
2007 fusion @ C4-6 peek cages, failed due to long term use of cox-2 inhibitor
2008 revised C4-6 donor bone, plate & screws
2009 fusion with Roi-C @ C3-4
2015 MRI & CT mjr ddd @ C6-7, segmental kyphosis at C7-T1, 2-level M6-C prosthesis by Dr. Clavel Barcelona Spain
2019 H.O. formed behind M6-C @ C6-7 left nerve rt & in spinal canal.
2020 Revision C6-7 to a CP-ESP prosthesis by Dr. Schmitz Dusseldorf Germany
Reply With Quote
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