Washington E-Newsletter

AANS and CNS Advocacy Results in CMS Rescinding Edit for Decompression Add-on Codes

Due to AANS and CNS leadership and advocacy, the Centers for Medicare & Medicaid Services (CMS) rescinded an incorrect National Correct Coding Initiative (NCCI) edit restricting the reporting of spinal fusion codes (Current Procedural Terminology (CPT®) codes 22630, 22632, 22633 and 22634) with decompression add-on codes (CPT codes 63052 and 63053). Unsatisfied with the agency’s original plan, the AANS and the CNS led a coalition letter effort urging a swift resolution. Following an Aug. 24 meeting, which was joined by representatives from the American Academy of Orthopaedic Surgeons and North American Spine Society, CMS stated it would resolve the error by Oct. 1. 

Until the error is corrected, CMS recommends that neurosurgeons submit claims for these services using modifier -59, Distinct Procedural Service. Alternatively, practices may hold claims for these codes until CMS corrects the error.