Neurosurgery Coding Alert

Question: Recently, our surgeon performed spinal fusion (22630) on an extremely obese patient. The surgeon feels as though the patients weight was a complicating factor in the surgery and subsequent recovery. Can we gain additional compensation for this, perhaps using modifier 22? Illinois Subscriber Answer: You could possibly attain additional reimbursement by appending modifier 22 (Increased procedural services) to 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace [other than for decompression], single interspace; lumbar). You would have to provide the payer with a full and convincing argument as to how and why the patients obesity substantially complicated the surgery and/or created significant additional work for the surgeon. Remember: CPT codes define a range of service. Some surgeries and recovery periods (payers include routine post-surgical care in the global surgical package) may be more difficult than others, just as some may progress more smoothly than usual. Only [...]