Forum - Questions & Answers
Spine fusion
Is it true the spine cases 22551,22552 & 22554 can only be performed in an outpatient setting now, if so where can I find this information on the CMS website?
re: Spine fusion
Depends. CERT audits have found some fusion codes billed as inpatient but not on inpatient list of procedures. Example:
CERT error findings:
• In 60 percent of these cases, the documentation did not support that the procedure was reasonable and necessary
• In 20 percent of these cases, the procedure was reasonable and necessary, but there was no physician’s order for admission
• In 20 percent of these cases, the procedure was reasonable and necessary, but the admission was not reasonable and necessary for an inpatient level of care (the billed spinal fusion procedure codes were not on the inpatient-only list)