CPT Code 22867

CPT code 22867 is for the insertion of a stabilization device with decompression, used in spinal surgeries to enhance stability and relieve pressure.

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What is CPT Code 22867

CPT code 22867 is used to describe the insertion of a stabilization device with decompression. This procedure typically involves placing a device to stabilize the spine while also relieving pressure on the spinal cord or nerves, which can help alleviate pain and improve function for patients with certain spinal conditions.

Does CPT 22867 Need a Modifier?

For CPT code 22867, which pertains to the insertion of a stabilization device with decompression, the following modifiers may be applicable:

1. Modifier 22 (Increased Procedural Services): Use this modifier if the procedure required significantly more work than typically required. This could be due to increased intensity, time, technical difficulty, severity of the patient's condition, or physical and mental effort required.

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 was accompanied by additional procedures.

4. Modifier 59 (Distinct Procedural Service): This modifier is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances. It indicates that the procedure was distinct or independent from other services performed on the same day.

5. Modifier 62 (Two Surgeons): Apply this modifier if two surgeons worked together as primary surgeons performing distinct parts of the procedure.

6. Modifier 76 (Repeat Procedure by Same Physician): Use this modifier if the same procedure was repeated by the same physician on the same day.

7. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when the same procedure is repeated by a different physician 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 of the initial surgery.

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 when an assistant surgeon is required for the procedure.

11. Modifier 81 (Minimum Assistant Surgeon): This modifier is used when a minimum assistant surgeon is required for the procedure.

12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Apply this modifier when an assistant surgeon is necessary because a qualified resident surgeon is not available.

13. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Use this modifier when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.

Each of these modifiers provides additional information about the circumstances under which the procedure was performed, ensuring accurate billing and appropriate reimbursement.

CPT Code 22867 Medicare Reimbursement

CPT code 22867 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services covered by Medicare, and it is updated annually to reflect changes in policy and practice. Additionally, reimbursement can vary based on the region and the specific Medicare Administrative Contractor (MAC) overseeing the claims. Each MAC may have different local coverage determinations (LCDs) that can affect whether and how a particular CPT code is reimbursed. Therefore, it is advisable to consult the MPFS and the relevant MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 22867.

Are You Being Underpaid for 22867 CPT Code?

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