CPT code 22551 is a medical code used to describe an anterior cervical discectomy and fusion procedure performed by healthcare providers.
CPT code 22551 is for a surgical procedure called "arthrodesis, anterior interbody, cervical." This means it is a surgery performed on the cervical spine (the neck region) where the surgeon fuses two or more vertebrae together from the front (anterior) to stabilize the spine and alleviate pain or other symptoms.
When billing for CPT code 22551 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); cervical below C2), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or other factors that increased the complexity of the surgery.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed bilaterally, this modifier should be appended to indicate that the surgery was done on both sides of the cervical spine.
3. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier should be used to indicate that 22551 is one of several procedures.
4. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. 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 particularly useful when billing for multiple procedures that are not typically reported together.
6. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure, this modifier should be used to indicate that both surgeons are equally responsible for the surgery.
7. Modifier 76 - Repeat Procedure by Same Physician: If the same physician needs to repeat the procedure, this modifier should be appended to indicate the repeat nature of the service.
8. Modifier 77 - Repeat Procedure by Another Physician: If another physician repeats the procedure, this modifier should be used to indicate that the repeat procedure was performed by a different provider.
9. 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 if the patient needs to return to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial surgery.
11. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier should be appended to indicate the involvement of an assistant.
12. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon is required for the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Use this modifier when a non-physician provider assists in the surgery.
These modifiers help provide additional context and specificity to the billing for CPT code 22551, ensuring accurate reimbursement and compliance with payer requirements.
Medicare does reimburse for CPT code 22551, which refers to "Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy, and decompression of spinal cord and/or nerve roots; cervical below C2." 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 22551 is approximately $1,500. However, it is essential to verify the exact reimbursement rate with your local MAC or through the Medicare Physician Fee Schedule (MPFS) for the most accurate and up-to-date information.
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 22551 for arthrodesis, anterior interbody, cervical. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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