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Related Concept Videos

Fractures: Bone Repair01:27

Fractures: Bone Repair

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Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
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Related Experiment Video

Updated: Jun 3, 2025

Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
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Impact of Modifier-22 on Reimbursement Following Acetabular Fracture Fixation.

Caleb J Bischoff1, Kylee Rucinski1, Wayne Hoskins1

  • 1Department of Orthopaedic Surgery, University of Missouri, Columbia, MO; and.

Journal of Orthopaedic Trauma
|January 10, 2025
PubMed
Summary

The 22-modifier for Current Procedural Terminology (CPT) surgery did not increase reimbursement for acetabular fracture fixation. Surgeons experienced longer operative times and higher billed charges without improved financial outcomes.

Keywords:
22-modifieracetabular fractureobesityoperative timereimbursement

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Area of Science:

  • Orthopedic Surgery
  • Health Economics
  • Medical Billing

Background:

  • The 22-modifier in Current Procedural Terminology (CPT) is intended to reflect increased surgical complexity and justify higher reimbursement.
  • Acetabular fracture fixation is a complex procedure where the 22-modifier may be applied due to factors like obesity or fracture severity.

Purpose of the Study:

  • To investigate the impact of the 22-modifier on reimbursement amounts for acetabular fracture fixation.
  • To compare financial reimbursement, billed charges, and operative times between cases with and without the 22-modifier.

Main Methods:

  • Retrospective cohort study of patients undergoing open acetabular fracture fixation between 2005 and 2021.
  • Comparison of a cohort using the 22-modifier (n=52) with a matched cohort without the 22-modifier (n=52) based on diagnosis, CPT code, and insurance carrier.
  • Analysis of primary outcome (reimbursement) and secondary outcomes (billed charges, operative time).

Main Results:

  • No significant difference in reimbursed amounts was found between the 22-modifier group ($4112.71) and the non-modifier group ($3851.00) (P = 0.644).
  • The 22-modifier group exhibited significantly higher billed charges ($8007.35 vs. $7120.94; P = 0.0096) and longer operative times (301.7 vs. 240.2 minutes; P < 0.001).
  • Patients in the 22-modifier group had a higher mean body mass index (43.1 vs. 29.3 kg/m²; P < 0.001).

Conclusions:

  • The application of the 22-modifier for acetabular fracture fixation did not lead to increased financial reimbursement despite greater complexity and higher billed charges.
  • Current reimbursement structures may not adequately compensate for the increased complexity associated with the 22-modifier in these cases.
  • Revision of reimbursement policies by policymakers and insurers is recommended to better align payments with the surgical complexity of acetabular fixation.