CPT code 22585 is for an additional anterior interbody arthrodesis procedure, which involves spinal fusion surgery.
CPT code 22585 is for an additional procedure involving the anterior interbody arthrodesis, which is a type of spinal fusion surgery. This code specifically refers to each additional vertebral segment that is treated during the surgery.
When billing for CPT code 22585 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); each additional interspace (List separately in addition to code for primary procedure)), 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. Since 22585 is an add-on code, it is typically exempt from modifier 51, but it is important to verify payer-specific guidelines.
2. Modifier 59 (Distinct Procedural Service): This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It may be necessary if 22585 is performed in conjunction with other procedures that are not typically reported together.
3. Modifier 62 (Two Surgeons): If two surgeons are required to perform the procedure, this modifier indicates that each surgeon is performing a distinct part of the procedure.
4. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used if the same physician needs to repeat the procedure on the same day.
5. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used if a different physician needs to repeat the procedure 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): This modifier is used if the patient needs to return 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): This modifier is used if the procedure is performed during the postoperative period of another procedure but is unrelated to the original procedure.
8. 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 according to the clinical scenario and payer guidelines to ensure accurate billing and reimbursement.
Medicare reimbursement for CPT code 22585, which refers to "Arthrodesis, anterior interbody technique, including minimal discectomy, each additional interspace," depends on several factors, including the specific Medicare Administrative Contractor (MAC) policies and the clinical context in which the procedure is performed. Generally, Medicare does reimburse for this code when it is deemed medically necessary and is performed in accordance with Medicare guidelines.
The reimbursement amount can vary based on geographic location, the setting of the procedure (e.g., hospital outpatient department vs. ambulatory surgical center), and other factors. As of the latest available data, the national average reimbursement rate for CPT code 22585 can range from approximately $1,000 to $2,000. However, it is crucial to verify the exact reimbursement rate with the specific MAC and to ensure that all documentation and coding are accurate to facilitate proper reimbursement.
For the most accurate and up-to-date information, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) and their local MAC guidelines.
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 22585 for arthrodesis. Ensure you're receiving accurate reimbursements from every payer. Schedule a demo today to see how RevFind can optimize your revenue cycle management.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
