CPT code 23076 is for the excision of a shoulder tumor that is deep and less than 5 cm in size.
CPT code 23076 is used to describe the surgical procedure for the excision of a deep tumor in the shoulder area that is less than 5 centimeters in size. This code is specific to the removal of tumors that are located beneath the surface tissues, requiring a more invasive approach compared to superficial tumor excisions.
When billing for CPT code 23076 (Excision of shoulder tumor, deep, less than 5 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 23076, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort than typically required. Documentation must support the increased complexity.
2. Modifier 50 - Bilateral Procedure
- Use this modifier if the procedure was performed on both shoulders during the same session.
3. Modifier 51 - Multiple Procedures
- Use this modifier if multiple procedures were performed during the same surgical session. This helps indicate that more than one procedure was carried out.
4. 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. This is particularly useful if another procedure was performed on a different site or through a separate incision.
5. Modifier LT - Left Side
- Use this modifier to specify that the procedure was performed on the left shoulder.
6. Modifier RT - Right Side
- Use this modifier to specify that the procedure was performed on the right shoulder.
7. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same procedure was repeated by the same physician on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if the same procedure was repeated by a different physician on the same day.
9. Modifier 78 - Unplanned Return to the Operating Room
- Use this modifier if the patient had to return to the operating room for a related procedure during the postoperative period.
10. 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.
11. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was required to perform the procedure.
12. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon was required for the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon was necessary because a qualified resident surgeon was not available.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted in the surgery.
Proper use of these modifiers can help ensure that claims are processed correctly and that the healthcare provider receives appropriate reimbursement for the services rendered. Always refer to the latest coding guidelines and payer-specific policies for the most accurate and up-to-date information.
The CPT code 23076 is reimbursed by Medicare, but its reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any applicable guidelines, healthcare providers should refer to the MPFS. Additionally, it is crucial to consult with the respective Medicare Administrative Contractor (MAC) for your region, as they may have specific local coverage determinations (LCDs) or additional requirements that could impact reimbursement for CPT code 23076.
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