CPT code 23071 is for the excision of a shoulder lesion measuring 3 cm or less, involving subcutaneous tissue.
CPT code 23071 is used to describe a surgical procedure where a lesion (such as a tumor or abnormal growth) is excised (removed) from the shoulder area, and the size of the lesion is 3 centimeters or larger. This code is specific to the shoulder and indicates that the lesion being removed is of a significant size, requiring precise surgical intervention.
For CPT code 23071, which refers to the excision of a shoulder lesion with a size greater than 3 cm, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Used when the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as increased complexity or time.
2. Modifier 50 (Bilateral Procedure): Applied if the procedure is performed on both shoulders during the same session.
3. Modifier 51 (Multiple Procedures): Used when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
4. Modifier 59 (Distinct Procedural Service): Indicates that the procedure is distinct or independent from other services performed on the same day. This could be due to different anatomical sites or separate patient encounters.
5. Modifier 76 (Repeat Procedure by Same Physician): Used if the same procedure is repeated by the same physician on the same day.
6. Modifier 77 (Repeat Procedure by Another Physician): Applied if the same procedure is repeated by a different physician on the same day.
7. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): Used if the patient requires an unplanned return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Indicates that the procedure is unrelated to the original procedure and is performed during the postoperative period.
9. Modifier LT (Left Side): Used to specify that the procedure was performed on the left shoulder.
10. Modifier RT (Right Side): Used to specify that the procedure was performed on the right shoulder.
11. Modifier 99 (Multiple Modifiers): Applied when more than four modifiers are necessary to describe the service provided.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 23071 is reimbursed by Medicare, but it is essential to verify its inclusion in the Medicare Physician Fee Schedule (MPFS) to determine the specific reimbursement rate. The MPFS provides a comprehensive list of services covered by Medicare and their corresponding payment amounts. Additionally, reimbursement for CPT code 23071 may vary depending on the region, as Medicare Administrative Contractors (MACs) have the authority to make local coverage determinations. Therefore, it is advisable to consult the relevant MAC for your area to confirm the reimbursement details for CPT code 23071.
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