CPT code 23120 is for the partial removal of the collar bone, a surgical procedure to excise a portion of the clavicle.
CPT code 23120 is used to describe the partial removal of the collar bone, also known as the clavicle. This procedure involves surgically excising a portion of the clavicle, typically to relieve pain, correct deformities, or address other medical conditions affecting the bone.
When billing for CPT code 23120 (Partial removal of the collar bone), it is essential to consider the appropriate modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of potential modifiers that could be used with CPT code 23120, along with the reasons for their use:
1. Modifier 50 - Bilateral Procedure
- Used if the procedure is performed on both sides of the body.
2. Modifier 51 - Multiple Procedures
- Applied when multiple procedures are performed during the same surgical session.
3. Modifier 59 - Distinct Procedural Service
- Used to indicate that the procedure is distinct or independent from other services performed on the same day.
4. Modifier 62 - Two Surgeons
- Applied when two surgeons work together as primary surgeons performing distinct parts of the procedure.
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 when 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 needs to 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
- Applied when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier 80 - Assistant Surgeon
- Used when an assistant surgeon is required for the procedure.
10. Modifier 81 - Minimum Assistant Surgeon
- Applied when a minimum assistant surgeon is required for the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Used when an assistant surgeon is required because a qualified resident surgeon is not available.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Applied when a non-physician provider assists in the surgery.
13. Modifier LT - Left Side
- Used to specify that the procedure was performed on the left side of the body.
14. Modifier RT - Right Side
- Used to specify that the procedure was performed on the right side of the body.
15. Modifier GC - This Service Has Been Performed in Part by a Resident Under the Direction of a Teaching Physician
- Applied when a resident performs the service under the supervision of a teaching physician.
16. Modifier QX - CRNA Service: with Medical Direction by a Physician
- Used when a Certified Registered Nurse Anesthetist (CRNA) provides anesthesia services under the medical direction of a physician.
17. Modifier QK - Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures Involving Qualified Individuals
- Applied when a physician provides medical direction for multiple anesthesia procedures.
By appropriately applying these modifiers, healthcare providers can ensure accurate coding, billing, and reimbursement for the partial removal of the collar bone procedure.
CPT code 23120 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services and procedures that Medicare covers, along with the associated payment rates. However, the actual reimbursement for CPT code 23120 can vary based on the region and the specific Medicare Administrative Contractor (MAC) overseeing the claims in that area. Each MAC has the authority to interpret Medicare policies and may have additional local coverage determinations (LCDs) that impact the reimbursement process. Therefore, it is essential for healthcare providers to consult the MPFS and their respective MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 23120.
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