CPT code 22812 is for arthrodesis, anterior interbody technique, involving 8 or more vertebral segments.
CPT code 22812 is used for a surgical procedure involving the correction of spinal deformities. Specifically, it refers to the arthrodesis (fusion) of eight or more vertebral segments in the spine. This procedure is typically performed to stabilize the spine and correct severe spinal deformities.
For CPT code 22812 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); 8 or more vertebral segments), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as increased intensity, time, technical difficulty, severity of the patient's condition, or physical and mental effort required.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
3. 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 be due to different sessions, different procedures, different sites, or separate incisions/excisions.
4. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
5. Modifier 66 - Surgical Team: Applied when a highly complex procedure is carried out by a surgical team, which may include surgeons, anesthesiologists, and other specialists.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Used when the same procedure is repeated by the same physician or other qualified healthcare professional.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Used when the same procedure is repeated by a different physician or other qualified healthcare professional.
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 when a patient requires a 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: Applied 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 for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Applied when a minimum assistant surgeon is required for 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: Applied 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.
Determining whether CPT code 22812 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); 8 or more vertebral segments) is reimbursed by Medicare involves checking the Medicare Physician Fee Schedule (MPFS) and Local Coverage Determinations (LCDs) or National Coverage Determinations (NCDs).
As of the latest updates, CPT code 22812 is generally reimbursed by Medicare, provided that the procedure meets the medical necessity criteria outlined by Medicare. The reimbursement amount can vary based on geographic location and specific Medicare Administrative Contractor (MAC) policies.
For example, the national average reimbursement for CPT code 22812 might be approximately $1,500 to $2,000, but this can fluctuate. To get the precise reimbursement amount, healthcare providers should refer to the MPFS or contact their local MAC.
It's crucial for healthcare providers to ensure that all documentation supports the medical necessity of the procedure to avoid claim denials. Additionally, verifying the latest fee schedule and coverage policies is recommended, as these can change annually.
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 22812 for arthrodesis. 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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