CPT code 22802 is for arthrodesis, posterior, for spinal deformity, involving 7 to 12 vertebral segments.
CPT code 22802 is used for a surgical procedure involving the arthrodesis (fusion) of a spinal deformity spanning 7 to 12 vertebral segments. This code is typically used when a surgeon performs a complex spinal fusion to correct significant spinal deformities such as scoliosis or kyphosis.
When billing for CPT code 22802 (Arthrodesis, posterior technique, 7 to 12 vertebral segments), 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 body).
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session. This helps indicate 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
- Use this modifier to indicate that the procedure is distinct or independent from other services performed on the same day.
6. Modifier 62 - Two Surgeons
- Apply this modifier when two surgeons work together as primary surgeons performing distinct parts of the procedure.
7. Modifier 66 - Surgical Team
- Use this modifier when a team of surgeons is required to perform the procedure due to its complexity.
8. Modifier 76 - Repeat Procedure by Same Physician
- This modifier is used if the same physician needs to repeat the procedure on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if a different physician repeats the procedure on the same day.
10. Modifier 78 - Unplanned Return to the Operating Room
- Use this modifier if the patient needs to 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
- This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
12. Modifier 80 - Assistant Surgeon
- Apply this modifier when an assistant surgeon is required to help with the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier when a minimum assistant surgeon is required for the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Apply this modifier when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
When determining if a specific CPT code, such as 22802 (Arthrodesis for spinal deformity, 7 to 12 vertebral segments), is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and Local Coverage Determinations (LCDs).
For CPT code 22802, Medicare does provide reimbursement, but the amount can vary based on several factors, including geographic location, the setting in which the procedure is performed (e.g., hospital outpatient department, ambulatory surgical center), and any applicable modifiers.
As of the latest update, the national average reimbursement rate for CPT code 22802 under the MPFS is approximately $1,500. However, this amount is subject to change and may differ based on the aforementioned factors. Providers should verify the exact reimbursement rate through the MPFS Look-Up Tool or consult their Medicare Administrative Contractor (MAC) for the most accurate and up-to-date information.
Additionally, it is important to ensure that all documentation and coding are accurate and complete 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 22802 for arthrodesis procedures involving 7-12 vertebral segments. 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.
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