tci Part B Insider - 2013 Issue 28

Reader Question: Extra Compensation for Obese Patient Case

Question: Recently, our surgeon performed spinal fusion (22630) on an extremely obese patient. The surgeon feels as though the patient’s weight was a complicating factor in the surgery and subsequent recovery. Can we gain additional compensation for this, perhaps using modifier 22? Answer: You could possibly obtain 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 patient’s obesity...

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