# Manipulation of spine under anesthesia



## nauger (Oct 1, 2009)

I am doing the billing for both the Physician and the Chiroprator performing CPT 22505 MUA of the spine.  
The physician is stating that they are performing it over a 3 day period.

How would we bill for both the physician and the Chiroprator?
How much should we charge?

The physician seems to think that they should get reimbursed a few thousand dollars for this procedure......

Thanks!


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## ASC CODER (Oct 1, 2009)

22505 facility Medicare payment 531.61 in Missouri
22505 physician payment 115.05 in Missouri

per 2008 coders desk reference
Spinal manipulation under anesthesia is performed mostly by osteopaths although orthopedists may also use it to treat spinal dysfunction  and alleviate neck and back pain.  The induction of anesthesa reduces muscle tone and the natural reflex actions so that the spine can be manipulated more effectively to restore joint function and reduce pain. The manipulations are carried out so as to break up fibrotic adhesions of the soft tissues in and around to the spinal joints. SMUA is usally followed by a week of daily rehablilitative manipulation to maintain joint mobility and prevent re adhesion of the fibrotic tissue.
10 global days


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## nauger (Oct 1, 2009)

Our Physicians are the Chiroprator and the Internal Medicine Physician.... Are there any specified modifiers that need to be used?  

Why is this Physician thinking he will receive more reimbursement than that?


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## FTessaBartels (Oct 1, 2009)

*22505 does NOT accept 62 modifier*

NOT my area of expertise, but I do not think that 22505 accetps the -62 (Co-surgeon) modifier, so I don't see how you could bill for both doctors in the same session. Or did I misunderstand your original question?

F Tessa Bartels, CPC, CEMC


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## ASC CODER (Oct 2, 2009)

First it has to be general anesthesia: CPT® Assistant January 1999 Volume 9 Issue 1 "What type of anesthesia must be used to report CPT codes 22505 and 23700? The code descriptors do not state the type of anesthesia that must be given. AMA Comment From a CPT coding perspective, codes having the descriptor “requiring anesthesia” mean requiring general anesthesia. Therefore, CPT codes 22505, Manipulation of spine requiring anesthesia, any region, and 23700, Manipulation under anesthesia, shoulder joint, including application of fixation apparatus (dislocation excluded) are both intended to report these services performed under general anesthesia. " Then it can only be reported ONCE CPT Assistant March 1997 Volume 7 Issue 3 "Musculoskeletal, 22505 (Q&A) How would you code manipulation of the spine under anesthesia for the specific areas of the spine (ie, cervical, thoracic, and lumbar)? AMA Comment From a CPT coding perspective, code 22505, Manipulation of spine requiring anesthesia, any region, should be reported only once, for any and all regions manipulated on that date. " THERE IS A 10 DAY GLOBAL


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