CPT Code 22864

CPT code 22864 is used for the removal of a total artificial disc at one interspace in the cervical spine.

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What is CPT Code 22864

CPT code 22864 is used to describe the surgical procedure for the removal of a total artificial intervertebral disc at a single interspace in the cervical spine. This code is specifically utilized when a surgeon removes an artificial disc that was previously implanted to replace a damaged or degenerated disc in the neck region. The procedure aims to alleviate pain and restore function by removing the artificial disc that may no longer be effective or has caused complications.

Does CPT 22864 Need a Modifier?

For CPT code 22864 (Removal of total disc arthroplasty, including all components, anterior approach, single interspace; cervical), the following modifiers may be applicable:

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 difficulty.

2. Modifier 51 (Multiple Procedures): Applied when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.

3. Modifier 59 (Distinct Procedural Service): Used to indicate that the procedure is distinct or independent from other services performed on the same day. This is particularly relevant if the removal of the disc arthroplasty is performed in conjunction with other procedures that are not typically performed together.

4. Modifier 76 (Repeat Procedure by Same Physician): Applied when the same procedure is repeated by the same physician. This could be relevant if the patient requires a second removal of disc arthroplasty at a different interspace.

5. Modifier 77 (Repeat Procedure by Another Physician): Used when the same procedure is repeated by a different physician. This might be applicable in a scenario where a second surgeon is required to perform the procedure.

6. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): This modifier is used if the patient needs to return to the operating room for a related procedure during the postoperative period of the initial surgery.

7. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Applied when the procedure is performed during the postoperative period of another surgery but is unrelated to the initial procedure.

8. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required to help perform the procedure.

9. Modifier 81 (Minimum Assistant Surgeon): Applied when a minimum assistant surgeon is required for the procedure.

10. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Used when an assistant surgeon is necessary because a qualified resident surgeon is not available.

11. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Applied when a non-physician provider assists in the surgery.

These modifiers help provide additional context and specificity to the billing and coding process, ensuring accurate reimbursement and documentation.

CPT Code 22864 Medicare Reimbursement

CPT code 22864 is subject to reimbursement by Medicare, but its eligibility for payment depends on several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource for determining whether a specific CPT code is reimbursed and at what rate. To ascertain if CPT code 22864 is covered, healthcare providers should consult the MPFS, which outlines the payment policies and rates for services rendered to Medicare beneficiaries.

Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide region-specific guidance on the reimbursement status of CPT code 22864. Providers should verify with their respective MAC to ensure compliance with local coverage determinations (LCDs) and any other pertinent guidelines that may affect reimbursement.

In summary, while CPT code 22864 can be reimbursed by Medicare, it is essential to review the MPFS and consult with the appropriate MAC to confirm coverage and payment specifics.

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