HOW TO BILL FOR MILD - MINIMALLY INVASIVE LUMBAR DECOMPRESSION - Prior Authorization Services, Patient Access Services & RCM

How to bill for mild - minimally invasive lumbar decompression

7/13/2021

updated: 04/12/2023 - READ HERE.
updated: 07/13/2022

This blog post provides a comprehensive guide on how to correctly bill for MILD (Minimally-Invasive Lumbar Decompression) procedures in the healthcare industry. With clear instructions and helpful tips, the post aims to assist healthcare providers in navigating the billing process, avoiding common errors, and maximizing reimbursements. Whether you are a physician, coder, or biller, this informative post from GoHealthcare Practice Solutions LLC can serve as a valuable resource for billing MILD procedures accurately and efficiently.

Some of my Pain Practice Offices are still confused on how to bill for MILD Procedure. As we all remember, there was no assigned CPT Code for this procedure, we used to report the unlisted code.

In this Blog, I will describe the billing and coding for this procedure using the Vertos Device (www.vertosmed.com

First, let's describe what is MILD?

MILD stands for MINIMALLY INVASIVE LUMBAR DECOMPRESSION.

HOW TO BILL FOR MILD - MINIMALLY INVASIVE LUMBAR DECOMPRESSION

HOW TO BILL FOR MILD - MINIMALLY INVASIVE LUMBAR DECOMPRESSION

CPT 0275T is a Category III Code assigned for this procedure.

0275T - Percutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy, and/or foraminotomy), any method, under indirect image guidance (eg. fluoroscopic, CT), single or multiple levels, unilateral or bilateral; lumbar.

(For percutaneous decompression of the nuleus pulposus of intervertebral disc utilizing needle based technique, use 62287)

So how do you report and bill for this MILD Procedure?

Billing on HCFA 1500 form?

Physician Claim:

Outpatient Hospital (POS 22)
ASC (POS 24)

CPT Category III Code 0275T is billable when reported as patient participating in a clinical study.

The following information has to appear and included in your claim submission:

Diagnosis Code (Primary: M48.062 - Spinal Stenosis, lumbar region with neurogenic claudication)
Diagnosis Code (Secondary: Z00.6 - Encounter for examination for normal comparison and control in clinical research program
National Clinical Trial (NCT) Number (enter on BOX 19) - 03072927 (number only if submission is by electronic. Enter CT03072927 if by paper submission.
CPT Category III Modifier - Q0 (** this is the letter Q and the numerical number ZERO, not the letter O).

Insurance Prior Authorization Services, Patients Access and Medical Documentation Reviews and Audits.

My additional recommendation (especially for Medicare beneficiaries): Enter the "referring physician" on Box 17 the same as the "rendering physician" on Box 24J since the assessment and treatment plan is that from the "Rendering Physician".

Image/Guidance Source: www.vertosmed.com

HOW TO BILL FOR MILD - MINIMALLY INVASIVE LUMBAR DECOMPRESSION

2022 GUIDANCE HOW TO BILL FOR MILD - MINIMALLY INVASIVE LUMBAR DECOMPRESSION BILLING GUIDANCE for the Procedure (NCTØ3Ø72927) - SOURCE VERTOS (SEE ATTACHMENT BELOW)