CPT Code 22840

CPT code 22840 is a medical code used to describe the procedure of inserting a spine fixation device.

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What is CPT Code 22840

CPT code 22840 is used for the procedure of inserting a spine fixation device. This code is typically applied when a surgeon places hardware, such as rods, screws, or plates, to stabilize the spine during spinal surgery.

Does CPT 22840 Need a Modifier?

For CPT code 22840 (Insert spine fixation device), the following modifiers may be applicable depending on the specific circumstances of the procedure:

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 complexity or time.

2. Modifier 50 - Bilateral Procedure: Applied if the procedure is performed on both sides of the spine 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 the procedure is one of several performed.

4. Modifier 59 - Distinct Procedural Service: Used to indicate that the procedure is distinct or independent from other services performed on the same day. This could be due to different anatomical sites or separate patient encounters.

5. Modifier 62 - Two Surgeons: Applied when two surgeons work together as primary surgeons performing distinct parts of the procedure.

6. Modifier 76 - Repeat Procedure by Same Physician: Used if the same physician needs to repeat the procedure on the same day.

7. Modifier 77 - Repeat Procedure by Another Physician: Applied if a different physician repeats the procedure on the same day.

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 the 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 the procedure is unrelated to the original surgery and occurs during the postoperative period.

10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required to help perform the procedure.

11. Modifier 81 - Minimum Assistant Surgeon: Applied 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 necessary due to the unavailability of a qualified resident surgeon.

13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Applied when these non-physician practitioners assist in the surgery.

Each modifier serves a specific purpose and should be used accurately to ensure proper billing and reimbursement. Always refer to the latest CPT and payer guidelines to confirm the appropriate use of modifiers.

CPT Code 22840 Medicare Reimbursement

Medicare does reimburse for CPT code 22840, which pertains to the insertion of a spinal fixation device. The reimbursement amount can vary based on several factors, including the specific Medicare Administrative Contractor (MAC) jurisdiction, the facility setting (inpatient vs. outpatient), and the geographical location. As of the latest available data, the national average reimbursement for CPT code 22840 under the Medicare Physician Fee Schedule (MPFS) is approximately $1,200. However, it is crucial to verify the exact reimbursement rate with the relevant MAC and consider any updates to the fee schedule or policy changes that may affect the reimbursement amount.

Are You Being Underpaid for 22840 CPT Code?

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