CPT code 22222 is a medical code used to describe the surgical procedure of anterior osteotomy for one vertebral segment in the thoracic spine.
CPT code 22222 is for an osteotomy procedure where a surgeon makes a cut in the bone to correct alignment or deformity, specifically targeting one vertebral segment in the thoracic (mid-back) region from the front (anterior) side.
For CPT code 22222 (Osteotomy, anterior, single vertebral segment; thoracic), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required. This could be due to increased intensity, time, technical difficulty, severity of the patient's condition, or physical and mental effort required.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
3. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
4. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure, each surgeon should report their distinct operative work by appending this modifier.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Used when a procedure or service is repeated by the same provider subsequent to the original procedure or service.
6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Applied when a procedure or service is repeated by another provider subsequent to the original procedure or service.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used when a patient requires a return to the operating room for a related procedure during the postoperative period of the initial surgery.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Indicates that the performance of a procedure or service during the postoperative period was unrelated to the original procedure.
9. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
10. Modifier 81 - Minimum Assistant Surgeon: Applied when an assistant surgeon provides minimal assistance during the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required, and a qualified resident surgeon is not available.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement for the services provided.
When determining if a specific CPT code, such as 22222 (Osteotomy, discectomy, anterior approach, single vertebral segment; thoracic), is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and Local Coverage Determinations (LCDs) provided by Medicare Administrative Contractors (MACs).
For CPT code 22222, Medicare does provide reimbursement, but the amount can vary based on geographic location and other factors. As of the latest update, the national average reimbursement for CPT code 22222 is approximately $1,500. However, this amount can fluctuate, so it is crucial to verify the specific reimbursement rate applicable to your practice's location by consulting the MPFS or contacting your local MAC.
Additionally, ensure that the procedure meets all medical necessity criteria outlined by Medicare to avoid claim denials. Proper documentation and adherence to Medicare guidelines are essential for successful reimbursement.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and identify underpayments down to the CPT code level, including specific codes like 22222 for osteotomy. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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