CPT code 22614 is for an additional spinal fusion procedure, specifically for each extra interspace beyond the first.
CPT code 22614 is used for the surgical procedure of arthrodesis, which is the fusion of a joint. Specifically, this code refers to the fusion of each additional interspace in the spine beyond the first one. This means that if a surgeon is fusing multiple segments of the spine, CPT code 22614 would be used for each additional segment after the initial one.
For CPT code 22614 (Arthrodesis, posterior or posterolateral technique, single level; 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 22614 is an add-on code, it is typically exempt from this modifier, 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 22614 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 distinct parts of the procedure, this modifier indicates that each surgeon is performing a separate part of the surgery.
4. Modifier 66 (Surgical Team): This modifier is used when a complex procedure requires the services of a surgical team.
5. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used if the same physician needs to repeat the procedure on the same day.
6. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used if a different physician needs to repeat the procedure on the same day.
7. 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.
8. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
10. Modifier 80 (Assistant Surgeon): This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 81 (Minimum Assistant Surgeon): This modifier is used when an assistant surgeon is required for a minimal part of the procedure.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available.
It is crucial to verify payer-specific guidelines and documentation requirements when applying these modifiers to ensure accurate billing and reimbursement.
When considering whether Medicare reimburses for CPT code 22614, which pertains to arthrodesis, posterior or posterolateral technique, single interspace, each additional interspace, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and Local Coverage Determinations (LCDs) for the most accurate and up-to-date information.
As of the latest update, CPT code 22614 is generally reimbursed by Medicare when it meets the medical necessity criteria outlined in the relevant LCDs. The reimbursement amount can vary based on geographic location and other factors. For instance, the national average reimbursement rate for CPT code 22614 is approximately $1,200, but this figure can fluctuate.
To ensure accurate billing and reimbursement, healthcare providers should verify the specific reimbursement rates and coverage policies through the MPFS and their local Medicare Administrative Contractor (MAC). Additionally, proper documentation supporting the medical necessity of the procedure is crucial for successful 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 22614 for arthrodesis procedures. Ensure you're receiving the full reimbursement you deserve from each payer. Schedule a demo today to see how RevFind can optimize your revenue cycle management.
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