CPT code 23073 is for the surgical excision of a deep tumor in the shoulder area that is larger than 5 cm.
CPT code 23073 is used to describe the surgical procedure for the excision (removal) of a deep tumor from the shoulder area that is 5 centimeters or larger in size. This code is specifically for deep tumors, which means the tumor is located beneath the superficial layers of tissue and requires more extensive surgical techniques to remove.
When billing for CPT code 23073 (Excision of tumor, soft tissue of shoulder area, deep, 5 cm or greater), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of potential modifiers that could be used with CPT code 23073, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort or complexity than typically required for the listed procedure.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both shoulders during the same operative session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures, other than E/M services, are performed by the same provider during the same session.
4. Modifier 59 - Distinct Procedural Service
- This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same procedure was repeated by the same physician on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if the same procedure was 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
- Use this modifier if the patient required 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
- This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier LT - Left Side
- Use this modifier to specify that the procedure was performed on the left shoulder.
10. Modifier RT - Right Side
- Apply this modifier to indicate that the procedure was performed on the right shoulder.
11. Modifier 99 - Multiple Modifiers
- Use this modifier when two or more modifiers are necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used according to the clinical scenario and payer guidelines to ensure proper coding and reimbursement.
CPT code 23073 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates. Additionally, the reimbursement for CPT code 23073 may vary depending on the region, as Medicare Administrative Contractors (MACs) have the authority to make local coverage determinations. Therefore, it is essential to consult the relevant MAC for your region to confirm the specific reimbursement details and any additional requirements for CPT code 23073.
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