Florida Blue Billing Laterality Modifiers

September 2018 ~

Florida Blue issued a notice to providers stating, effective this month, the insurer will implement edits for several spinal surgery procedures when billed in conjunction with lumber spinal fusion codes, including spinal cord decompression and laminectomy, facetectomy and foraminotomy procedures.

According to the notice, the insurer is making these changes in accordance with CMS’ National Correct Coding Initiative billing guidelines, which indicate that modifier 59 and its subsets should not allow additional payment when appended to CPT codes 63047, 63048, 63056 and/or 63057 when performed in conjunction with 22630, 22632, 22633 and/or 22634.

Based on the most common clinical scenario, it is expected that when these services are billed with a lumbar arthrodesis, posterior interbody technique, the procedures are being performed on the same level. In the unusual clinical circumstance when the procedures are performed at different vertebral levels, this can be reviewed upon appeal with submission of clinical information.

The following are the code combinations impacted by these edits. When these code combinations are billed to Florida Blue, the spinal cord decompression, laminectomy, facetectomy and/or foraminotomy procedure will be denied.

Spinal Cord Decompression Procedures

  • 63056/22630
  • 63057/22630
  • 63056/22632
  • 63057/22632
  • 63056/22633
  • 63057/22633
  • 63056/22634
  • 63057/22634

Laminectomy, Facetectomy and Foraminotomy Procedures

  • 63047/22633
  • 63048/22633
  • 63047/22634
  • 63048/22634

These changes became effective as of effective September 2018 and apply to all Florida Blue health plans except BlueCard® Home and Medicare Supplement plans.

 

CPT® is a registered trademark of the American Medical Association.

 

Source(s): Florida Blue Bulletin September 2018;

 

 

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