CPT code 22586 is for arthrodesis, pre-sacral interbody technique, at the L5-S1 spinal segment.
CPT code 22586 is used for a surgical procedure called "arthrodesis," specifically at the L5-S1 level of the spine. This involves fusing the bones in the lower back (lumbar spine) to the top of the sacrum to stabilize the spine and alleviate pain or other symptoms caused by conditions like degenerative disc disease or spondylolisthesis.
When billing for CPT code 22586 (Arthrodesis, pre-sacral interbody technique, including disc space preparation, discectomy, with or without decompression (decompression to include laminectomy, facetectomy and/or foraminotomy) L5-S1 interspace), 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. Documentation must support the substantial additional work and the reason for the additional work.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body during the same operative session.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
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. This modifier is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances.
6. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct part(s) of a procedure.
7. Modifier 66 - Surgical Team: Used when a team of surgeons (more than two) is required to perform a specific procedure.
8. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Used to indicate that a procedure or service was repeated subsequent to the original procedure or service.
9. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Used to indicate that a procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service.
10. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period: Used when a related procedure is performed during the postoperative period of the initial procedure.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
12. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: Used when an assistant surgeon is required for a short duration during the procedure.
14. 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.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in 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 any modifier.
Medicare reimbursement for CPT code 22586, which pertains to arthrodesis of the presacral interbody at the L5-S1 level, depends on several factors including the specific Medicare Administrative Contractor (MAC) jurisdiction, the setting in which the procedure is performed (e.g., inpatient vs. outpatient), and the patient's specific Medicare plan.
As of the latest available data, Medicare does reimburse for CPT code 22586 when the procedure is deemed medically necessary and is performed in an appropriate setting. The reimbursement amount can vary based on geographic location and other factors. For instance, in an outpatient setting, the national average reimbursement rate for CPT code 22586 might range from approximately $1,500 to $2,500. However, these figures are subject to change and should be verified with the specific MAC for the most accurate and up-to-date information.
Healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) or their local MAC for precise reimbursement rates and any specific documentation requirements to ensure proper billing and reimbursement for this procedure.
Discover how MD Clarity's RevFind software can read your contracts and detect underpayments with precision. With RevFind, you can identify discrepancies down to the CPT code level, including specific codes like 22586 for arthrodesis, pre-sacral interbody, L5-S1, and by individual payer. Ensure you're receiving the full reimbursement you deserve. 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
