CPT code 22520 is a medical billing code for percutaneous vertebroplasty in the thoracic spine, a procedure to stabilize spinal fractures.
CPT code 22520 is for a procedure called percutaneous vertebroplasty of the thoracic spine. This involves injecting a special cement into a fractured vertebra in the thoracic (mid-back) region to stabilize it and relieve pain.
When billing for CPT code 22520 (Percutaneous vertebroplasty, one vertebral body, thoracic), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of modifiers that could be used with CPT code 22520, along with the reasons for their use:
1. Modifier 50 - Bilateral Procedure
- Use this modifier if the procedure is performed on both sides of the thoracic spine during the same session.
2. Modifier 51 - Multiple Procedures
- Apply this modifier when multiple procedures, including 22520, are performed during the same surgical session.
3. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the procedure is distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the same physician performs the procedure more than once on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if a different physician performs the procedure more than once on the same day.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Apply this modifier if the patient returns to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if the procedure is performed during the postoperative period of another procedure but is unrelated to the initial procedure.
8. Modifier LT - Left Side
- Apply this modifier if the procedure is performed on the left side of the thoracic spine.
9. Modifier RT - Right Side
- Use this modifier if the procedure is performed on the right side of the thoracic spine.
10. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Apply this modifier if the procedure involves an assistant at surgery who is a physician assistant, nurse practitioner, or clinical nurse specialist.
11. Modifier GC - This Service Has Been Performed in Part by a Resident Under the Direction of a Teaching Physician
- Use this modifier when a resident performs the procedure under the supervision of a teaching physician.
12. Modifier Q6 - Service Furnished by a Locum Tenens Physician
- Apply this modifier if the procedure is performed by a locum tenens physician who is temporarily filling in for the regular physician.
By appropriately applying these modifiers, healthcare providers can ensure accurate coding, billing, and reimbursement for CPT code 22520.
Medicare does reimburse for CPT code 22520, which pertains to percutaneous vertebroplasty of the thoracic spine. However, the reimbursement amount can vary based on several factors, including geographic location, the specific Medicare Administrative Contractor (MAC), and whether the procedure is performed in a hospital outpatient setting or an ambulatory surgical center.
As of the latest available data, the national average reimbursement rate for CPT code 22520 under the Medicare Physician Fee Schedule (MPFS) is approximately $1,000 to $1,200. It's important to consult the most recent Medicare fee schedule or your local MAC for the exact reimbursement amount applicable to your practice.
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 22520 for percutaneous vertebroplasty thoracic procedures. Ensure you're receiving accurate reimbursements from every payer. Schedule a demo today to see RevFind in action and protect your revenue.
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