Spine-related surgical procedures are usually complex to bill. This is because accuracy depends on understanding not just the codes, but also the surgical approach, the spinal region involved, and the number of interspaces or vertebral segments treated.
However, the complexity does not ruleout the necessity of accurate coding for spine surgery. Medical billers must stay informed with the ever-changing CPT code guidelines and documentation requirements to maximize reimbursement and minimize denials.
For the same reason, we have prepared this guide on CPT code 22633, which outlines the detailed description of the code with the most common clinical scenarios for the correct application of this code. To find further information related to the billing of this code, keep reading!
CPT Code 22633 – Description
CPT code 22633 refers to a spinal fusion, also known as arthrodesis. This surgical procedure is performed by combining posterior and posterolateral techniques at a single vertebral level.
This surgery is performed to treat conditions causing instability or pain in the lower spine, such as degenerative disc disease, spondylolisthesis, or severe spinal stenosis. During the surgery, the healthcare provider fuses the affected vertebrae to provide stability, reduce pain, and improve overall spinal function.
Scenarios Where CPT Code 22633 is Applicable
Did you find the description a little hard to understand? The following scenarios will help you understand the real-world applications of CPT code 22633.
Chronic Lower Back Pain
Suppose a 48-year-old woman who works at an office in a 9-5 setting presents with chronic lower back pain lasting over three years. She has previously tried various pain-relieving methods like physical therapy, chiropractic care, epidural steroid injections, and activity modification. Unfortunately, she only found temporary relief from these methods.
Her orthopedic spine surgeon suggests a lumbar spinal fusion using a posterior interbody and posterolateral technique to stabilize the affected segment. A laminectomy and discectomy are performed to prepare the interspace before arthrodesis. In this case, CPT code 22633 is appropriate because the procedure involves a combined posterior and interbody fusion at a single lumbar level.
Degenerative Disc Disease
In another scenario, let’s imagine a 55-year-old patient comes with advanced degenerative disc disease in the lumbar region with persistent mechanical back pain and reduced mobility. MRI confirms significant disc collapse, hence the surgeon performs a posterior lumbar interbody fusion (PLIF), removing the damaged disc along with posterior instrumentation to stabilize the spine.
Since the procedure combines posterior arthrodesis and interbody fusion at a single lumbar segment, CPT code 22633 is correctly reported.
Severe Spinal Stenosis
Now consider a 67-year-old patient who suffers from severe pain that begins in the lower back and extends down to his leg, continuing to his foot. His MRI reveals a spinal stenosis where the space around his spinal cord becomes too narrow. After trying conservative treatment methods and multiple procedures, healthcare providers use spinal fusion as a last option because spinal fusion surgery permanently joins (fuses) two vertebrae together.
During surgery, the surgeon performs a laminectomy and discectomy to relieve pressure on the spinal cord and nerve roots. Since the laminectomy and disc removal are done as part of the preparation for interbody and posterolateral fusion (not solely decompression), and fusions are performed at one interspace, CPT code 22633 is appropriate.
Applicable Modifiers for CPT Code 22633
Since CPT code 22633 is a surgical procedure, you may apply assistant at surgery modifiers to the code if any assistance was provided.
Modifier 80
When an assistant surgeon assists the principal surgeon during the entire procedure, modifier 80 is applied to CPT code 22633. The assistant surgeon is typically reimbursed at 16% to 20% of the allowed amount.
Modifier 82
Modifier 82 may be used with CPT code 22633 to indicate that an assistant surgeon was required because a qualified resident surgeon was unavailable at the time.
Modifier AS
Modifier AS is used when a non-physician practitioner assists in surgery, such as a Physician Assistant (PA), Nurse Practitioner (NP), or Clinical Nurse Specialist (CNS). With modifier AS, the assistant is reimbursed between 10% and 16%, depending on the payer.
CPT Code 22633 – Billing & Reimbursement Guidelines
Here are some essential billing and reimbursement guidelines for CPT code 22633. The following information can help you file accurate and error-free claims to the payer.
Maintain Paperwork
Inaccurate or incomplete documentation is a major reason for claim denials. If your paperwork lacks important details that payers usually look for before reimbursement, they might reject your payment. Hence, it is vital to stay relevant and comply with the payer’s requirements in your documents. The following are some essential points that must be a part of your documents.
- MRI reports
- Details of previously failed treatments (to justify the medical necessity)
- Operative notes
- Surgical approach used
- Levels operated (e.g., L4-L5)
- Instrumentation or implants used
- Additional procedures
Be Mindful of the Global Period
The global period is usually applied to surgical procedures and is also applicable to CPT code 22633. There is a 90-day post-operative period for this code. So the payment against 22633 includes reimbursement for services rendered during the pre-operative phase, the surgery itself, and 90 days immediately following the day of surgery.
Understand Bundling Rules for 22633
CPT code 22633 is a comprehensive code that represents the combination of a posterior lumbar interbody fusion (22630) and a posterolateral fusion (22612), making it a higher-level (global) code that already includes the work of the others. Hence, you cannot separately bill these two services if both were performed in the same session.
Final Words
We believe that this guide has made coding for spinal fusions, particularly for arthrodesis, a little easier to understand. Here is a short overview of everything we have discussed above:
CPT code 22633 refers to an arthrodesis (spinal fusion) procedure at a single interspace in the lumbar region of the spine. The provider uses a combined approach to fuse the vertebrae laterally and vertically. Some other points to bear in mind are:
- Apply assistant at surgery modifiers as required.
- Maintain proper documentation to prove the medical necessity.
- The code has a 90-day global period.
- Do not unbundle lumbar interbody and posterolateral fusions.
However, if we have missed any detail here or you are still confused about the billing of CPT code 22633, you can opt for professional orthopedic billing services from MediBillMD.
