October 16, 2014
I keep getting a denial when we bill 22855 for the removal of anterior hardware at C5-C6 when I bill it with 22845. The old hardware at C5-C6 was removed so that I could put new hardware on at C4-C5 as part of an ACDF. Someone told me to put modifier 59 on 22855 so that it would be paid. Should I?
No. CPT guidelines state: “Only the appropriate insertion code (22840-22848) should be reported when previously placed spinal instrumentation is being removed or revised during the same session where new instrumentation is inserted at levels including all or part of the previously instrumented segments.” You’ve got C5 as an overlapping level between the old and new instrumentation; therefore, it would not be appropriate to bill 22855 for the removal. You would bill only for the placement of new instrumentation (22845). Forcing payment on 22855 by appending modifier 59 is not appropriate.