April 11, 2019

Question:
We are being told by our billing service that “CPT 22551 as the procedure/diagnosis code combination is not compatible” when we use the diagnosis code of M50.11 for an ACDF at C3 -4.  This is the first time that we have ever had an issue with M50.11 for 22551.  Is there something that we are missing?

Answer:
Wow, I had not heard of this before you wrote it.  So, I looked into it and found it is not something YOU are missing.  It is something that the billing service’s software is missing when they are checking for “acceptable” diagnosis codes for 22551.  I decided to look at the diagnosis crosscodes for 22551 on the coding software we use at KZA.  I found even that software does not list any cervical disc disorder diagnosis codes addressing pathology for C2-C3 or C3-C4 as acceptable for 22551.  That’s so crazy and must be an oversight in the software.  I suggest you ask/request your billing service to go ahead and bill the diagnosis code anyway and override whatever error message they are getting.  Hopefully coding software vendors will take note and correct this issue.

*This response is based on the best information available as of 4/11/19.