CPT Code 22220

CPT code 22220 is a medical code used to describe the surgical procedure of anterior osteotomy for one vertebral segment in the cervical spine.

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What is CPT Code 22220

CPT code 22220 is for a surgical procedure called an osteotomy, specifically performed on the anterior (front) part of one vertebral segment in the cervical (neck) region of the spine. This procedure involves cutting and reshaping the bone to correct alignment or relieve pressure.

Does CPT 22220 Need a Modifier?

For CPT code 22220 (Osteotomy, posterior or posterolateral approach, single vertebral segment; cervical), 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 increased intensity, time, technical difficulty, or physical and mental effort.

2. Modifier 50 - Bilateral Procedure: If the osteotomy is performed on both sides of the cervical spine, this modifier should be used to indicate a bilateral procedure.

3. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier should be used to indicate that more than one procedure was performed.

4. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.

5. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day. It is often used to bypass National Correct Coding Initiative (NCCI) edits.

6. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure is repeated by the same physician, this modifier should be used.

7. Modifier 77 - Repeat Procedure by Another Physician: If the same procedure is repeated by a different physician, this modifier should be used.

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: Use this modifier 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: This modifier is used if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.

10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier should be used.

11. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon is required for the procedure.

12. 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.

13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: This modifier is 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.

CPT Code 22220 Medicare Reimbursement

When determining if a specific CPT code, such as 22220 (Osteotomy, discectomy, anterior, single vertebral segment; cervical), is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and Local Coverage Determinations (LCDs).

For CPT code 22220, Medicare does provide reimbursement, but the amount can vary based on geographic location and other factors. As of the latest update, the national average reimbursement for CPT code 22220 is approximately $1,200. However, this amount can fluctuate, so it is advisable to verify the exact reimbursement rate through the MPFS or your local Medicare Administrative Contractor (MAC).

Additionally, it is important to ensure that the procedure meets all Medicare coverage criteria and documentation requirements to avoid claim denials. Always check for any specific guidelines or pre-authorization requirements that may apply to this code.

Are You Being Underpaid for 22220 CPT Code?

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