Washington E-Newsletter

CMS Proposed Edit for Decompression Add-on Codes Rescinded

On June 23, staff for the Centers for Medicare & Medicaid Services (CMS) National Correct Coding Initiative (NCCI) reached out to the AANS and the CNS, stating that as of July 1, NCCI edits would be implemented that restrict the reporting of spinal fusion codes 22630, 22632, 22633 and 22634 with add-on decompression codes 63052 and 63053. In the same notice to our societies, CMS acknowledged this was an error and will delete this edit as soon as possible. Neurosurgeons should brace themselves for the possibility that the deletion may not occur until Jan. 1, 2024. Fortunately, CMS stated that the edit deletion would be retroactive to July 1.

To bypass this erroneous code pair error, CMS recommends that from July 1 until the error is corrected, neurosurgeons should submit claims for these services using modifier 59, Distinct Procedural Service. Alternatively, practices may hold claims for these codes until CMS has corrected the error and submit at that time.

NCCI edits are intended to prevent inappropriate payment of services that should not be reported together. However, these edits were clearly inaccurate since the add-on codes 63052 and 63053 were explicitly created to be used with the interbody fusion codes 22630-22634. Similar inappropriate NCCI edits for these codes were proposed last year, but the AANS/CNS Coding and Reimbursement Committee leaders led a call with CMS staff to review the history of the codes. Following this conversation, on Feb. 7, 2022, CMS agreed not to implement the edits.

Rest assured, AANS/CNS Coding and Reimbursement Committee leaders and Washington Office Staff are aware of the disruption and confusion caused by this error and are seeking further clarification from CMS and NCCI on this issue. If you have questions or problems related to this or other coding and reimbursement issues, contact the Washington Office staff at reimbursement@neurosurgery.org.

For more information on the history of these codes, click here and here.