CPT code 22804 is for arthrodesis to correct deformity in 13 or more vertebral segments.
CPT code 22804 is for a surgical procedure involving the correction of spinal deformities. Specifically, it refers to the arthrodesis (surgical fusion) of 13 or more vertebral segments. This procedure is typically performed to stabilize the spine and correct severe spinal deformities.
When billing for CPT code 22804 (Arthrodesis, posterior technique, for spinal deformity, with or without cast; 13 or more vertebral segments), the following modifiers may be applicable:
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 the complexity of the patient's condition or the extent of the deformity.
2. Modifier 51 (Multiple Procedures): Apply this modifier if multiple procedures were performed during the same surgical session. This indicates that more than one procedure was carried out, which may affect reimbursement.
3. 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 is particularly useful if the arthrodesis was performed in conjunction with other procedures that are not typically reported together.
4. Modifier 62 (Two Surgeons): Use this modifier if two surgeons were required to perform the procedure together, each acting as a primary surgeon. This is often necessary for complex surgeries involving multiple vertebral segments.
5. Modifier 66 (Surgical Team): Apply this modifier if the procedure required a surgical team due to its complexity. This indicates that multiple professionals were involved in the surgery, each contributing their expertise.
6. Modifier 76 (Repeat Procedure by Same Physician): Use this modifier if the same physician had to repeat the procedure on the same day. This could be due to complications or the need for additional surgical intervention.
7. Modifier 77 (Repeat Procedure by Another Physician): Apply this modifier if a different physician had to repeat the procedure on the same day. This might occur in cases where the initial surgery was incomplete or complications arose.
8. Modifier 78 (Unplanned Return to the Operating Room): Use this modifier if the patient had to return to the operating room for a related procedure during the postoperative period. This indicates that the return was unplanned and related to the initial surgery.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Apply this modifier if an unrelated procedure was performed by the same physician during the postoperative period of the initial surgery. This helps differentiate the new procedure from the postoperative care of the initial surgery.
10. Modifier 80 (Assistant Surgeon): Use this modifier if an assistant surgeon was necessary for the procedure. This indicates that another surgeon assisted the primary surgeon during the operation.
11. Modifier 81 (Minimum Assistant Surgeon): Apply this modifier if a minimum assistant surgeon was required. This indicates that the assistant's involvement was limited but necessary.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Use this modifier if an assistant surgeon was required because a qualified resident surgeon was not available. This is often used in teaching hospitals.
13. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Apply this modifier if a non-physician provider assisted in the surgery. This indicates that a PA, NP, or CNS provided assistant services during the procedure.
These modifiers help provide additional context and detail about the procedure, ensuring accurate billing and appropriate reimbursement.
Medicare reimbursement for CPT code 22804, which pertains to arthrodesis for deformity involving 13 or more vertebral segments, is subject to specific criteria and guidelines. Generally, Medicare does reimburse for this procedure if it is deemed medically necessary and meets the coverage requirements outlined by the Centers for Medicare & Medicaid Services (CMS).
The reimbursement amount can vary based on several factors, including geographic location, the setting in which the procedure is performed (e.g., inpatient hospital, outpatient facility), and the specific Medicare Administrative Contractor (MAC) policies. As of the latest available data, the national average reimbursement for CPT code 22804 can range from approximately $2,000 to $3,500. However, it is crucial to verify the exact reimbursement rate with the relevant MAC and consider any updates to the Medicare Physician Fee Schedule (MPFS).
For the most accurate and up-to-date information, healthcare providers should consult the CMS website or their local MAC.
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