CPT code 22634 is used for billing an additional spinal fusion procedure, combining multiple interspaces.
CPT code 22634 is used for the surgical procedure involving the arthrodesis (fusion) of the spine at each additional interspace. This code is applied when a surgeon performs a spinal fusion at more than one intervertebral level, beyond the initial level addressed by the primary procedure code.
For CPT code 22634 (Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; each additional interspace and segment), 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. This could apply if the arthrodesis procedure is more complex or time-consuming than usual.
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 is relevant if CPT code 22634 is performed in conjunction with other procedures.
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 could apply if the arthrodesis is performed in a different anatomical site or through a separate incision.
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: Used if the same procedure is repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician: Used if the same procedure is repeated by a different physician.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used if the patient needs to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used if 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 for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when a qualified resident surgeon is not available, and an assistant surgeon is required.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement for the services provided.
Determining if a specific CPT code, such as 22634 (Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; each additional interspace and segment), is reimbursed by Medicare involves several steps.
Medicare typically reimburses for medically necessary procedures that meet specific criteria. CPT code 22634 is generally covered by Medicare when it is deemed medically necessary and is performed in accordance with Medicare guidelines. However, the reimbursement amount can vary based on several factors, including geographic location, the setting of the procedure (inpatient vs. outpatient), and the specific Medicare Administrative Contractor (MAC) policies.
To find the exact reimbursement amount for CPT code 22634, healthcare providers can refer to the Medicare Physician Fee Schedule (MPFS) or use the Medicare Administrative Contractor's fee schedule lookup tool. As of the latest update, the national average reimbursement for CPT code 22634 can range from approximately $1,200 to $1,500, but this amount can vary.
For the most accurate and up-to-date information, providers should consult the MPFS or their local MAC. Additionally, verifying coverage and reimbursement specifics through the Medicare Coverage Database or contacting Medicare directly can provide further clarity.
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 22634 for arthrodesis combined with each additional interspace. Ensure you're receiving the full reimbursement you deserve from every payer. Schedule a demo today to see RevFind in action and safeguard your revenue.
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
