CPT code 22630 is for arthrodesis, posterior interbody technique, including laminectomy and/or discectomy, single interspace, lumbar.
CPT code 22630 is for a surgical procedure called "arthrodesis, posterior technique, single interspace, lumbar." This means it refers to a spinal fusion surgery performed on the lower back (lumbar region) using a posterior approach to fuse one intervertebral space.
For CPT code 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace and segment; lumbar), 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 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.
5. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
6. 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.
7. 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 qualified healthcare professional subsequent to the original procedure or service.
8. 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.
9. 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.
10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used when an assistant surgeon is required for a minimal portion of the procedure.
12. 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.
13. 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 of these modifiers 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 22630: Arthrodesis, Posterior Technique, Single Interspace, Lumbar
CPT code 22630, which refers to arthrodesis using a posterior technique for a single interspace in the lumbar region, is generally reimbursed by Medicare. However, the reimbursement amount can vary based on several factors, including geographic location, the specific Medicare Administrative Contractor (MAC), and the facility where the procedure is performed (e.g., hospital outpatient department vs. ambulatory surgical center).
As of the most recent data, the national average reimbursement rate for CPT code 22630 under the Medicare Physician Fee Schedule (MPFS) is approximately $1,200 to $1,500. This amount can fluctuate, so it is crucial to consult the latest MPFS or your local MAC for the most accurate and up-to-date reimbursement information.
For precise reimbursement rates, healthcare providers should refer to the Medicare Physician Fee Schedule Look-Up Tool or contact their local MAC. Additionally, it's important to ensure that all documentation and coding are accurate to avoid claim denials or delays in reimbursement.
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 22630 for arthrodesis procedures. Ensure you're receiving the full reimbursement you deserve from every payer. Schedule a demo today to see how RevFind can optimize your revenue cycle management and protect your bottom line.
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