CPT code 22523 is a medical code used for billing percutaneous kyphoplasty in the thoracic spine, a procedure to treat spinal fractures.
CPT code 22523 is for a percutaneous kyphoplasty procedure performed on the thoracic spine. This minimally invasive surgery is used to treat spinal fractures, often caused by osteoporosis, by stabilizing the vertebrae with a special cement.
For CPT code 22523 (Percutaneous vertebroplasty, including cavity creation (fracture reduction and bone biopsy included when performed), one vertebral body, 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.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same session.
4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. 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.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Used when the same procedure is repeated by the same provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Used when the same procedure is repeated by a different provider.
8. 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 related procedure is performed during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same provider during the postoperative period.
10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required for the procedure.
12. 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.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician providers assist in surgery.
14. Modifier LT - Left Side: Used to indicate the procedure was performed on the left side of the body.
15. Modifier RT - Right Side: Used to indicate the procedure was performed on the right side of the body.
16. Modifier QX - CRNA Service: With Medical Direction by a Physician: Used when a Certified Registered Nurse Anesthetist (CRNA) provides anesthesia services under the medical direction of a physician.
17. Modifier QY - Medical Direction of One CRNA by an Anesthesiologist: Used when an anesthesiologist provides medical direction for one CRNA.
18. Modifier QK - Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures Involving Qualified Individuals: Used when an anesthesiologist provides medical direction for multiple anesthesia procedures.
19. Modifier QS - Monitored Anesthesia Care Service: Used to indicate monitored anesthesia care.
20. Modifier G8 - Monitored Anesthesia Care (MAC) for Deep Complex, Complicated, or Markedly Invasive Surgical Procedure: Used for monitored anesthesia care in complex or invasive procedures.
21. Modifier G9 - Monitored Anesthesia Care for Patient Who Has History of Severe Cardiopulmonary Condition: Used for monitored anesthesia care in patients with severe cardiopulmonary conditions.
These modifiers help provide additional information about the procedure and ensure accurate billing and reimbursement. Always verify with current coding guidelines and payer-specific requirements.
Medicare does reimburse for CPT code 22523, which pertains to percutaneous kyphoplasty of the thoracic spine. The reimbursement amount can vary based on several factors, including geographic location and specific Medicare Administrative Contractor (MAC) policies. As of the latest available data, the national average reimbursement for CPT code 22523 is approximately $1,100 to $1,300. However, it is essential to verify the exact reimbursement rate with your local MAC to ensure accurate billing and reimbursement.
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 22523 for percutaneous kyphoplasty thoracic procedures. Ensure you're receiving the full reimbursement you deserve from every payer. Schedule a demo today to see RevFind in action and protect your revenue.
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