CPT code 23075 is for the excision of a shoulder lesion smaller than 3 cm.
CPT code 23075 is used to describe a surgical procedure where a lesion (abnormal tissue) smaller than 3 centimeters is excised (removed) from the shoulder area. This code is specific to the shoulder and indicates that the lesion being removed is relatively small in size.
When billing for CPT code 23075 (Excision of shoulder lesion, subcutaneous, less than 3 cm), 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 23075, 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.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both shoulders during the same session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services
- Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the same procedure was repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if the same procedure was repeated by a different physician on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Apply this modifier if the patient required an unplanned return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if an unrelated procedure was performed by the same physician during the postoperative period of the initial procedure.
10. Modifier LT - Left Side
- Apply this modifier to specify that the procedure was performed on the left shoulder.
11. Modifier RT - Right Side
- Use this modifier to specify that the procedure was performed on the right shoulder.
12. Modifier XS - Separate Structure
- Apply this modifier to indicate that a service was performed on a separate organ/structure.
13. Modifier XE - Separate Encounter
- Use this modifier to indicate that a service was performed during a separate encounter.
14. Modifier XP - Separate Practitioner
- Apply this modifier to indicate that a service was performed by a different practitioner.
15. Modifier XU - Unusual Non-Overlapping Service
- Use this modifier to indicate that a service does not overlap usual components of the main service.
Proper use of these modifiers can help ensure that claims are processed correctly and that healthcare providers receive appropriate reimbursement for their services. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
CPT code 23075 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates. Additionally, it is crucial to consult with your local Medicare Administrative Contractor (MAC) to confirm any regional variations or specific guidelines that may affect reimbursement for CPT code 23075. The MACs are responsible for processing Medicare claims and can provide detailed information on coverage and payment policies specific to your area.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 23075, and by individual payer. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.
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