CPT Code 22851

CPT code 22851 is for applying a spinal prosthetic device, used in surgeries to support or replace parts of the spine.

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What is CPT Code 22851

CPT code 22851 is used to describe the procedure of applying a spinal prosthetic device. This code is typically utilized when a surgeon places an implant, such as an artificial disc or other prosthetic device, into the spine to replace a damaged or degenerated disc. This procedure is often part of spinal fusion surgeries or other spinal corrective surgeries aimed at alleviating pain, restoring function, and improving the structural integrity of the spine.

Does CPT 22851 Need a Modifier?

When using CPT code 22851 for the application of a spinal prosthetic device, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is an ordered list of potential modifiers and the reasons for their use:

1. Modifier 22 (Increased Procedural Services)
- Use this modifier if the procedure required significantly greater effort or complexity than typically required.

2. Modifier 50 (Bilateral Procedure)
- Apply this modifier if the procedure was performed bilaterally during the same operative session.

3. Modifier 51 (Multiple Procedures)
- Use this modifier when multiple procedures are performed during the same surgical session.

4. Modifier 58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period)
- Apply this modifier if the procedure was planned or staged at the time of the original procedure.

5. Modifier 59 (Distinct Procedural Service)
- Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.

6. Modifier 62 (Two Surgeons)
- Apply this modifier if two surgeons were required to perform the procedure together.

7. Modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional)
- Use this modifier if the same procedure was repeated by the same physician.

8. Modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional)
- Apply this modifier if the procedure was repeated by a different physician.

9. 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 had to return to the operating room for a related procedure during the postoperative period.

10. 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.

11. Modifier 80 (Assistant Surgeon)
- Use this modifier if an assistant surgeon was necessary for the procedure.

12. Modifier 81 (Minimum Assistant Surgeon)
- Apply this modifier if a minimum assistant surgeon was required.

13. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available))
- Use this modifier if an assistant surgeon was necessary due to the unavailability of a qualified resident surgeon.

14. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery)
- Use this modifier if a non-physician provider assisted in the surgery.

Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.

CPT Code 22851 Medicare Reimbursement

The CPT code 22851 is not reimbursed by Medicare. According to the Medicare Physician Fee Schedule (MPFS), this specific code is considered non-covered. Medicare Administrative Contractors (MACs) follow the guidelines set forth by the MPFS and, as such, do not provide reimbursement for CPT code 22851. Healthcare providers should verify the coverage status of this code with their respective MAC to ensure compliance and accurate billing practices.

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