Hello all,

We received payment from BCBS PPO for Redo Lumbar 4-5 Laminectomy L4-5 TLIF. The office billed CPT codes 22633-22, 22842, 22853, 63042, 63044, 63056, 60057 and all got paid for but CPT code 63042, I was wonder if we were missing something.

Please see the attached OP Note:

Procedures:

1. Redo bilateral L4 laminotomies and foraminotomies, decompression bilateral L4 nerve roots.

2. Redo bilateral L5 laminotomies and foraminotomies, decompression bilateral L5 nerve roots.

3. Right L4 transpedicular approach with far lateral decompression right L4 nerve root

4. Right L5 transpedicular approach with far lateral decompression right L5 nerve root

5. L4-L5 TLIF procedure with a titanium titan interbody cage.

6. L4-L5 posterior lateral arthrodesis with local morselized autograft and DBM.

7. Left sided L4-L5 RTI pedicle screws

8. Modifier 22 for extra degree of difficulty given the severe amount of collapse and scarring from prior surgery, which all required extensive careful microdissection bilaterally and adding over an hour to the standard surgical procedure.

9. Microscope for microdissection of spinal canal.

10. SSEP, EMG monitoring and intraoperative screw stimulation performed by neuro monitoring associates, which remained stable throughout.

INTRAOPERATIVE FINDINGS: Severe stenosis and collapse at L4-5, which was decompressed widely and the disk space opened up and distracted up well with a Titan interbody TLIF cage. There was dense scarring at the L4-L5 level and microdissection and it should be reflected in the primary coding.

Any help and pointing me in right direction.

Thank You in advance!!!

Jessica