Missing levels and prior-auth denials cost spine practices recoverable revenue every day.
Spine runs fusions, decompressions, and instrumentation with per-level add-on coding, heavy medical-necessity review, and staged approaches side by side. Manual billing teams under-capture a fraction of the levels and add-ons. Ember catches all of them.
Trusted by specialty groups and health systems
Where spine revenue leaks
The denial patterns Ember was built for
Spine surgery is among the most prior-auth-scrutinized procedures in medicine, and its coding is per-level and add-on heavy. Medical-necessity review, dropped levels, and staged approaches compound into systematic underpayment. Ember closes each gap.
01 · Prior auth & medical necessity
Auth and documentation denials on high-dollar fusions and decompressions.
Spine surgery faces the strictest payer criteria in medicine. Conservative-care duration, imaging correlation, and indications documentation gaps trigger denials on high-dollar cases, and auth obtained doesn't always match the payer's current policy. Ember flags the missing criteria before the service and builds the appeal package when denials occur.
22633 · 63047 · 22853 · 6238002 · Per-level & add-on coding
Dropped additional-level and instrumentation add-on codes on multi-level cases.
Arthrodesis and decompression are billed per level, and the primary plus additional-level add-on codes and instrumentation add-ons are routinely dropped on multi-level cases. Every missed add-on level or interbody device becomes an underpayment on an already high-dollar claim. Ember captures every level and instrumentation add-on before submission.
+22634 · +63048 · +22845 · 2285303 · Global periods, staged & co-surgeon
Staged anterior/posterior and co-surgeon denials inside the 90-day global.
Spine cases carry a 90-day global period, run staged anterior/posterior, and often involve two surgeons. Missing modifier 62 co-surgeon documentation and 58/78 staged and related modifiers collapse separately payable work into one denial. Ember applies the right modifiers and tracks staged procedures through the global period.
22551 · 22552 · 62 · 58 · 78Three engines.
One source of truth.
Ember connects clinical documentation, payer policy, and contract terms into a single intelligence layer. Built for the per-level, instrumentation-heavy, auth-intensive work spine billing spans every day.
01 · Foundation
Data Engine
Bridges the clinical and the financial. Unifies documentation, coding decisions, payer policy, and contracts across every encounter and provider.
R. Okafor
Encounter #S-30514
02 · Audit
Coding Engine
Reviews 100% of encounters against national standards, payer-specific policies, your internal guidelines, and your payer contracts. Every flag carries a rule citation.
Add +22634 — each additional interbody level
CPT add-on · confidence 0.96
03 · Recovery
Appeal Engine
Reads CARC and RARC codes, identifies the applicable LCD/NCD policy and contract terms, drafts the appeal letter, packages documentation, and tracks every claim to adjudication.
Re: Claim #S-30514 · Denial CO-50
Lumbar fusion meets medical-necessity criteria under LCD L39741: documented 6-month conservative care and imaging-correlated instability, per contract §4.7…
Audit upstream.
Appeal downstream.
Two workflows do most of the work for spine practices. The first prevents denials before they happen. The second recovers the ones that slip through.
Pre-bill audit
Catch the missing add-on level before the claim leaves.
Ember reviews every encounter against coding standards, payer surgical and medical-necessity policy, and your contracts. Dropped levels, instrumentation add-on gaps, and prior-auth issues are flagged before submission.
- 1
Ingest the encounter
Pulls operative notes, level-by-level documentation, instrumentation logs, and procedure codes from your EHR and practice management system.
- 2
Validate against rules
Checks per-level add-on and instrumentation coding, prior-auth and medical-necessity status, staged and co-surgeon modifiers, and global-period rules against each payer's specific policies.
- 3
Recommend with citation
Returns the suggested correction tied to the exact payer policy, LCD, CPT add-on rule, or contract term.
- 4
Educate the provider
Coding patterns drive provider-level coaching, so operative note documentation and level-by-level charge capture improve across every surgeon.
Add +22634 — second interbody level documented, not billed
CPT add-on · confidence 0.97
+23%
Clean-claim rate
100%
Encounters reviewed
+5%
Net collection rate
Automated appeals
Pull. Review. Push.
When a denial occurs, Ember identifies the root cause, retrieves operative notes, instrumentation logs, and conservative-care documentation, references payer policy and contract terms, drafts the appeal, and tracks it through adjudication.
Medical necessity
Missing information
Add-on level bundling
Auth required, not on file
Lumbar fusion appeal
-57%
Denial rate
-45%
Cost to collect
+9.3%
Net revenue per appt
The full revenue cycle
From eligibility to adjudication. Covered.
Audit and appeals are the workhorses, but Ember protects spine revenue at every stage of the cycle.
Eligibility Verification
Confirms active coverage and surgical benefit structure before the case, and flags high-dollar implant and instrumentation coverage gaps before they become billing problems.
Prior Authorization
The biggest lever in spine. Checks auth requirements in real time for fusions, decompressions, instrumentation, and advanced imaging, verifies conservative-care and imaging correlation, generates medical-necessity documentation, and submits to payer portals automatically.
AI Medical Coding
Reviews 100% of encounters, per-level arthrodesis and decompression, instrumentation add-ons, and interbody devices, against national standards and payer rules before claims submit.
Pre-bill Audit
Predicts and prevents denials before claims go out, catching dropped levels, missing add-on and instrumentation codes, and medical-necessity issues before they generate write-offs.
Denial Management
Full appeal lifecycle for every spine denial type, medical necessity, auth failure, add-on level bundling, and modifier error, tracked to adjudication.
Underpayment Recovery
Parses contracts to model what each surgical and implant claim should pay, then surfaces line-item underpayments on high-dollar spine and instrumentation claims at scale.
High-value spine revenue, recovered
-57%
denial rate
-45%
cost to collect
100%
encounters audited
3 days
to first results
Based on Ember AI benchmarks across customer practices. Results vary by payer mix and specialty.
Frequently asked questions
Everything you need to know about how Ember fits into your revenue cycle.
- 50-75% reduction in FTE hours
- Faster cash acceleration
- Prevent 55%+ of denials
We provide ROI benchmarks and dashboards so you can track outcomes from day one.
See what your spine practice is leaving on the table
Bring us 30 days of denial data. We'll show you where the revenue is and exactly how Ember would recover it.