CPT code 22328 is used for treating each additional spinal fracture.
CPT code 22328 is used for the treatment of each additional spinal fracture. This code is typically added to the primary procedure code when multiple spinal fractures are being treated during the same surgical session.
When billing for CPT code 22328, which is used for the treatment of each additional spinal fracture, the following modifiers may be applicable:
1. Modifier 51 (Multiple Procedures): This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed on the same day.
2. Modifier 59 (Distinct Procedural Service): This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
3. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used when the same procedure is repeated by the same physician on the same day. It indicates that the procedure was necessary and not a duplicate billing error.
4. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when the same procedure is repeated by a different physician on the same day. It signifies that the procedure was necessary and not a duplicate billing error.
5. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): This modifier is used when a patient returns to the operating room for a related procedure during the postoperative period of the initial surgery.
6. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial surgery.
7. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
8. Modifier 24 (Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period): This modifier is used when an evaluation and management service provided during the postoperative period is unrelated to the original procedure.
9. Modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service): This modifier is used when a significant, separately identifiable evaluation and management service is performed on the same day as the procedure.
10. Modifier 26 (Professional Component): This modifier is used when only the professional component of the service is being billed, typically for services that have both a professional and technical component.
11. Modifier 62 (Two Surgeons): This modifier is used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
12. Modifier 66 (Surgical Team): This modifier is used when a team of surgeons is required to perform a complex procedure.
13. Modifier 80 (Assistant Surgeon): This modifier is used when an assistant surgeon is required to assist with the procedure.
14. Modifier 81 (Minimum Assistant Surgeon): This modifier is used when an assistant surgeon is required for a minimal portion of the procedure.
15. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available.
16. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery): This modifier is used when a non-physician practitioner assists in the surgery.
Each modifier serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement. Proper documentation is essential to support the use of these modifiers.
When determining if a specific CPT code, such as 22328 (Treat each additional spine fracture), is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and Local Coverage Determinations (LCDs).
As of the latest update, CPT code 22328 is reimbursed by Medicare. The reimbursement amount can vary based on geographic location and other factors. For precise reimbursement rates, healthcare providers should refer to the MPFS or use the Medicare Fee Schedule Lookup Tool available on the Centers for Medicare & Medicaid Services (CMS) website.
To ensure accurate billing and reimbursement, it is also advisable to check for any specific guidelines or documentation requirements associated with this CPT code in your region.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 22328 for treating each additional spine fracture. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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