CPT code 22633 is used for billing a combined arthrodesis procedure involving one interspace in the lumbar spine.
CPT code 22633 is used for a combined arthrodesis (spinal fusion) procedure at a single interspace in the lumbar region of the spine. This code covers both the anterior (front) and posterior (back) approaches to the spine in one surgical session.
When billing for CPT code 22633 (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; lumbar), 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. Documentation must support the substantial additional work and the reason for the additional work.
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 modifier indicates that multiple services are provided, and it helps in the correct sequencing of the codes.
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 is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
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 or Other Qualified Health Care Professional: Used to indicate that a procedure or service was repeated subsequent to the original procedure or service.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Used to indicate that a procedure or service was repeated by another physician or qualified healthcare professional subsequent to the original procedure or service.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional 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 or Other Qualified Health Care Professional During the Postoperative Period: Used to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used when an assistant surgeon is required for a minimal portion of 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: Used when these non-physician practitioners assist in surgery.
These modifiers help in providing additional information about the performed procedure, ensuring accurate billing and reimbursement. Proper documentation is essential to support the use of these modifiers.
Medicare Reimbursement for CPT Code 22633: Arthrodesis, Combined Posterior or Posterolateral Technique, Single Interspace, Lumbar
CPT code 22633 pertains to a surgical procedure involving arthrodesis, or spinal fusion, using a combined posterior or posterolateral technique at a single interspace in the lumbar region. This procedure is typically performed to alleviate pain and stabilize the spine in patients with conditions such as degenerative disc disease, spondylolisthesis, or spinal stenosis.
Medicare Reimbursement:
Medicare does reimburse for CPT code 22633, provided that the procedure is deemed medically necessary and meets the criteria outlined by Medicare guidelines. The reimbursement amount can vary based on several factors, including geographic location, the specific Medicare Administrative Contractor (MAC), and the setting in which the procedure is performed (e.g., hospital outpatient department, ambulatory surgical center).
As of the most recent data, the national average reimbursement rate for CPT code 22633 under the Medicare Physician Fee Schedule (MPFS) is approximately $1,500 to $2,000. However, this amount can fluctuate based on the aforementioned factors. For the most accurate and up-to-date reimbursement information, healthcare providers should consult the Medicare Fee Schedule Lookup Tool or contact their local MAC.
Key Considerations:
1. Medical Necessity: Ensure that the procedure is documented as medically necessary according to Medicare's guidelines.
2. Pre-authorization: Some Medicare Advantage plans may require pre-authorization for this procedure.
3. Documentation: Proper and thorough documentation is crucial for reimbursement. This includes detailed operative reports and patient medical records.
By adhering to these guidelines and staying informed about the latest Medicare policies, healthcare providers can optimize their reimbursement for CPT code 22633.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and identify underpayments down to the CPT code level, including specific codes like 22633 for arthrodesis combined with interbody technique in the lumbar spine. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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
