Cervical Artificial Disc Replacement Approval Letter (5/15/09): Blue Cross Blue Shield of TX

[Justin]

Please see the attached approval letter from Blue Cross Blue Shield of Texas for Cervical ADR.

[Justin]

Congrats by the way! This letter will benefit the SPS community.

[Justin]

Bumping this up for a member.

[jss]

This approval letter shows the critical importance of the provider using the correct procedure codes if the insurance company is to pre-certify an ADR. This approval was achieved by the provider using procedure codes 63075 and 76001.

63075 - Diskectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical, single interspace
76001 - Fluoroscopy, physician time more than one hour, assisting a non-radiologic physician (eg, nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy)

I have a denial letter from Blue Cross Blue Shield of Texas that used the 22856 procedure code.

22865 - TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, INCLUDING DISCECTOMY WITH END PLATE PREPARATION (INCLUDES OSTEOPHYTECTOMY FOR NERVE ROOT OR SPINAL CORD DECOMPRESSION AND MICRODISSECTION), SINGLE INTERSPACE, CERVICAL

Following that I have an approval letter that uses 22899 and 0090T.

22899 - Unlisted procedure, spine
0090T - (total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than decompression), cervical; single interspace

[Justin]

jss,

Thanks for posting the information above. I do hope the Cervical Artificial Disc Replacement Approval Letter helps with your appeal. Good luck and keep us posted!

[Jeff]

Thanks for this site,

I don't have time for an appeals process and while it appears my insurance company approved this proceedure approves this better surgery, my doctors staff claims they don't. perhaps with this letter and post below and some other articles and documents i found can quickly get this done. my surgeon and ortho were surprised i wasn't having some partial paralasys after seeing my mri and were stunned i didn't have a problem with my arm/hand... i have the mri and have seen it and while am not a doctor, am eager to not being a walking time bomb and in and out of the emergency room and hospital, not to mention all the drugs. i couldn't stand the thought of having fusion, only to have another surgery soon for above and or below it... i'm very thankful this site was here and i was able to find it... i have bcbstx and possibly because of your site and it's members, i can be put back together properly... any referrals in houston area ? this doctor seems competent and i he sucessfully operated on my lower back in 2005, but now has 3 locations and it is difficult dealing with his staff to say the least... refferal welcome quickly as i am trying to schedule the surgery pronto.

Sincerely,

Jeff

[ahennefer]

what peer reviews, med journals, letters where used to successfully get the proceedure coverage granted.

I'm trying to build a case and must submit everything within the next 7 days.

thanks.

[thumoeides]

I too am looking at getting a predetermination from BCBS of Texas and would like any information used in appeal.

Would it be possible to find out the name of the doctor and patient from the approval letter?

[dyates]

As of yesterday, I was informed by BCBSTX that the 0092T is no longer an excepted code. The only ones allowed is 22856, 22861, 22864.

They approved the 22856 yesterday for one level and sent 1 letter approving 0092T/ x2, then another denying coverage after the Dr. questioned the approval.

I feel completely shafted by the dr office. I had a 3 level approval..... BUT, the dr is one of the best in North America and in the top 3 in North Texas..... so how do I get the best care when they just want my money...

When looking at the codes, the top row is excepted and all below the comma are deleted... BCBSIL/Provider Medical Policies on Fyiblue