Medical Policy Updates

Notification of Policy Revisions Effective Jun 19, 2011 (Posted March 15, 2011)

Medical Policy	Revision
Modifier Guidelines	Added Modifier -59 will not allow additional payment when appended to CPT4 codes 63005, 63012, 63017, 63030, 63035, 63042, 63044, 63047 and 63048 and when performed in conjunction with 22630 and 22632. Lumbar laminectomy, facetectomy and foraminotomy procedures are typically considered incidental to the lumbar arthrodesis, posterior interbody technique; and therefore are not eligible for separate reimbursement. Changes to policy reviewed by Senior Medical Director 3/10/2011. Notification given 3/15/2011. Policy effective 6/19/2011. Added "same group practice" to modifier 24.
BUNDLING GUIDELINES	Lumbar Laminectomy, Facetectomy or Foraminotomy reported with a Lumbar Spinal Fusion - When a lumbar laminectomy, facetectomy or foraminotomy is performed with a posterior approach for a lumbar spinal fusion procedure, the laminectomy is generally incidental, and should be bundled with the fusion. When a claim is submitted reporting a posterior lumbar spinal fusion (22630/ 22632) and one of the following laminectomy procedures, 63005, 63012, 63017, 63030, 63035, 63042, 63044, 63047 and 63048, the laminectomy will be denied as incidental to the primary procedure, even if the 59 modifier is appended. New 2011 CPT codes added to Critical Care Services and Neonatal Intensive Care sections. Allergen Immunotherapy and Ultrasonic Guidance for Needle Biopsy sections were removed as they do not apply to this policy any longer. Notification 3/15/2011 with an Effective date of 6/19/2011.

Medical Policy

Revision

Modifier Guidelines

Added Modifier -59 will not allow additional payment when appended to CPT4 codes 63005, 63012, 63017, 63030, 63035, 63042, 63044, 63047 and 63048 and when performed in conjunction with 22630 and 22632. Lumbar laminectomy, facetectomy and foraminotomy procedures are typically considered incidental to the lumbar arthrodesis, posterior interbody technique; and therefore are not eligible for separate reimbursement. Changes to policy reviewed by Senior Medical Director 3/10/2011. Notification given 3/15/2011. Policy effective 6/19/2011. Added "same group practice" to modifier 24.

BUNDLING GUIDELINES

Lumbar Laminectomy, Facetectomy or Foraminotomy reported with a Lumbar Spinal Fusion - When a lumbar laminectomy, facetectomy or foraminotomy is performed with a posterior approach for a lumbar spinal fusion procedure, the laminectomy is generally incidental, and should be bundled with the fusion. When a claim is submitted reporting a posterior lumbar spinal fusion (22630/ 22632) and one of the following laminectomy procedures, 63005, 63012, 63017, 63030, 63035, 63042, 63044, 63047 and 63048, the laminectomy will be denied as incidental to the primary procedure, even if the 59 modifier is appended. New 2011 CPT codes added to Critical Care Services and Neonatal Intensive Care sections. Allergen Immunotherapy and Ultrasonic Guidance for Needle Biopsy sections were removed as they do not apply to this policy any longer. Notification 3/15/2011 with an Effective date of 6/19/2011.