Orthopedic surgery: spine · Nationwide
Billing for orthopedic spine surgery
Spine cases are some of the highest-dollar claims a practice sends. Authorization, multi-level coding and surgeon modifiers have to be right the first time, and underpayments have to be caught.
Where spine surgery practices lose money
Prior authorization
Payers often want documented conservative care and imaging before approving surgery. We check that the approval matches the planned levels and procedures.
Multi-level and add-on coding
Additional levels, instrumentation and bone graft are coded separately. Missing one means lost revenue on every case.
Co-surgeon and assistant claims
Co-surgeon and assistant-at-surgery modifiers have their own payer rules. We make sure each surgeon's claim is right.
High-dollar underpayments
We compare payments with your contracted rates and appeal underpaid claims, including peer-to-peer requests when needed.
What we handle
- Cervical and lumbar fusion
- Decompression and discectomy
- Instrumentation and bone graft add-ons
- Co-surgeon and assistant-at-surgery billing
- Workers' comp and personal injury claims
- Contract underpayment review
Also included
AI front desk
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How it worksFAQ
Orthopedic surgery: spine billing questions
How are multi-level spinal fusions coded?
The first level is billed with the primary procedure code and each additional level with an add-on code. Instrumentation and bone graft are usually reported with their own codes. Each one has to be supported by the operative note.
What do payers require before approving spine surgery?
Most commercial payers want documented conservative care, such as physical therapy, medication or injections over several weeks, plus imaging that matches the levels planned. The approval should list the same levels and procedures the surgeon performs.
How are co-surgeon and assistant claims billed?
When two surgeons each perform a distinct part of one procedure, each bills the same code with modifier 62 and is paid a share of the fee. An assistant at surgery uses modifier 80, 81 or 82, and some payers do not pay assistants for certain codes.
What happens if the surgery differs from what was authorized?
Contact the payer quickly: many allow an authorization update within a short window after surgery. A claim for levels or procedures that were not authorized is likely to be denied.
See your numbers first
Free revenue audit for spine surgery practices. Written report, no obligation.