CPT code 23101 is a medical code used to describe shoulder joint surgery procedures for billing and documentation purposes.
CPT code 23101 is used to describe a surgical procedure involving the shoulder joint. Specifically, this code refers to the excision or removal of a portion of the clavicle (collarbone) at the acromioclavicular joint, which is where the clavicle meets the highest point of the shoulder blade. This procedure is typically performed to relieve pain or restore function in patients with conditions such as arthritis or injury affecting the shoulder joint.
For CPT code 23101, which pertains to shoulder joint surgery, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Used when the work required to perform the procedure is substantially greater than typically required.
2. Modifier 50 - Bilateral Procedure: Used when the same procedure is performed on both shoulders during the same operative session.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
7. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.
8. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician.
9. 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 when a related procedure is performed during the postoperative period of the initial procedure.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
11. Modifier LT - Left Side: Used to indicate that the procedure was performed on the left shoulder.
12. Modifier RT - Right Side: Used to indicate that the procedure was performed on the right shoulder.
13. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
14. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required and a qualified resident surgeon is not available.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Used when these non-physician practitioners assist in the surgery.
These modifiers help provide additional information about the circumstances under which the shoulder joint surgery was performed, ensuring accurate billing and reimbursement.
CPT code 23101 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 the corresponding payment rates. However, the final determination of reimbursement for CPT code 23101 may also depend on the guidelines and policies set by the Medicare Administrative Contractor (MAC) for your specific region. MACs are responsible for processing Medicare claims and ensuring compliance with Medicare regulations, which can sometimes result in variations in coverage and reimbursement. Therefore, it is essential to consult both the MPFS and your regional MAC to confirm the reimbursement status and any specific requirements for CPT code 23101.
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