CPT Code 22853

CPT code 22853 is used for the insertion of a biomechanical device during spinal surgery to provide stability and support.

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What is CPT Code 22853

CPT code 22853 is used to describe the insertion of a biomechanical device, such as an intervertebral body fusion device, during spinal surgery. This code is specifically utilized when a surgeon places a device between the vertebrae to help stabilize the spine and promote bone fusion. The procedure typically involves the use of cages, spacers, or other implants designed to maintain proper spinal alignment and support the fusion process.

Does CPT 22853 Need a Modifier?

When billing for CPT code 22853 (Insertion of interbody biomechanical device(s) (e.g., synthetic cage(s), mesh(es) with integral anterior instrumentation for device anchoring (e.g., screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace), the following modifiers may be applicable:

1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than usual, which is documented in the patient's medical record.

2. Modifier 50 - Bilateral Procedure: Apply this modifier if the procedure was performed on both sides of the body during the same operative session.

3. Modifier 51 - Multiple Procedures: Use this modifier when multiple procedures are performed during the same surgical session. This helps indicate that the primary procedure is 22853, and additional procedures were also performed.

4. 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 helps to avoid bundling issues.

5. Modifier 62 - Two Surgeons: Apply this modifier if two surgeons of different specialties are required to perform the procedure together.

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

7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used 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: 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: Apply this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.

10. Modifier 80 - Assistant Surgeon: Use this modifier if an assistant surgeon is required for the procedure.

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

12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier if an assistant surgeon is required 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 a PA, NP, or CNS assists in the surgery.

These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.

CPT Code 22853 Medicare Reimbursement

CPT code 22853 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services and their corresponding reimbursement rates, which are updated annually. To determine the exact reimbursement rate for CPT code 22853, healthcare providers should refer to the MPFS.

Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and ensuring compliance with Medicare policies. They may have local coverage determinations (LCDs) that provide further guidance on the reimbursement criteria for CPT code 22853. Therefore, it is essential for healthcare providers to consult both the MPFS and their respective MACs to ensure accurate billing and reimbursement for CPT code 22853.

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