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TLIF Screw Placement

Nicole Posted Wed 25th of July, 2018 16:33:23 PM
The doctor was called into surgery to help on an emergent basis (patient was anesthetized with an open wound)... The primary surgeon was performing a L4-5 TLIF and there were some technical difficulties with placement of the screws. Therefore, my doctor personally placed screws bilaterally at L4 and L5 on the left side. Is this something that my provider can bill to the insurance? The code in question would be the 22840 and since this is an add-on code it needs to be billed with a primary code. All my physician did was assist with the placement of screws, so I feel like this, unfortunately, cannot be billed? Any suggestions on this?
SuperCoder Answered Thu 26th of July, 2018 03:46:53 AM

Hi Nicole,

If operating physician decides to perform surgery alone but due to some minor problem, he/she may call the assistant surgeon for a short period of time, then the assistant physician should bill the same CPT code which is being billed by the operating physician, with modifier 81 (Minimum Assistant Surgeon). 

Please feel free to write if you have any question.


Nicole Posted Thu 26th of July, 2018 14:40:30 PM
So my doctor would bill for the TLIF codes (22633/22853/22840) with an -81 modifier, even if my doctor only performed the placement of the screws? It just seems like that would not be right, since he did not do anything in regards to the rest of the surgery.
SuperCoder Answered Fri 27th of July, 2018 02:57:40 AM

You do not need to bill all the procedures. Just bill the procedure which your doctor did assist.


Nicole Posted Fri 27th of July, 2018 15:54:16 PM
That was my original question. My doctor only performed the placement of the screws (instrumentation). Therefore that would be CPT code 22840. Since that is an add-on code and cannot be billed as a stand-alone code, will the doctor be able to bill anything for the portion of the procedure that he did?
SuperCoder Answered Mon 30th of July, 2018 01:34:22 AM

Hi Nicole, 

This is a good question. In such a case where the CPT code is an Add-on code, then we should bill the primary code (i.e. 22633) with modifier 81.


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