CPT code 22612 is for a surgical procedure involving the arthrodesis of one interspace in the lumbar spine.
CPT code 22612 is used for the surgical procedure of arthrodesis, which is the fusion of the spine, specifically at one interspace in the lumbar region. This involves joining two or more vertebrae to eliminate motion between them, often to relieve pain or correct a spinal deformity.
When billing for CPT code 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar), several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more work than typically required. This could be due to factors such as increased complexity or time.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed bilaterally (on both sides of the lumbar spine).
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session. This indicates that more than one procedure was carried out.
4. Modifier 52 - Reduced Services
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service
- Apply this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
6. Modifier 62 - Two Surgeons
- Use this modifier when two surgeons work together as primary surgeons performing distinct parts of the procedure.
7. Modifier 66 - Surgical Team
- This modifier is used when a complex procedure requires the services of a surgical team.
8. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the same physician repeats the procedure on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if a different physician repeats the procedure on the same day.
10. 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 when the patient requires an unplanned return to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
12. Modifier 80 - Assistant Surgeon
- Use this modifier when an assistant surgeon is required for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- This modifier is used when a minimum assistant surgeon is required for the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier when an assistant surgeon is required because a qualified resident surgeon is not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
Medicare does reimburse CPT code 22612, which refers to arthrodesis, posterior or posterolateral technique, single interspace, lumbar. The reimbursement amount can vary based on several factors, including geographic location and specific Medicare Administrative Contractor (MAC) policies. As of the latest data, the national average reimbursement for CPT code 22612 is approximately $1,500. However, it is essential to verify the exact amount 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 read your contracts and detect underpayments down to the CPT code level, including specific codes like 22612 for arthrodesis, posterior technique, single interspace lumbar. 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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