CPT code 23125 is a medical billing code used to describe the surgical removal of the collar bone.
CPT code 23125 is the medical billing code used to describe the surgical procedure for the removal of the collar bone, also known as the clavicle. This code is used by healthcare providers to document and bill for the specific service of excising the clavicle, which may be necessary due to conditions such as severe fractures, tumors, or infections that cannot be treated through other means.
When billing for CPT code 23125 (Removal of collar bone), 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 23125, along with the reasons for their use:
1. Modifier 22 (Increased Procedural Services):
- Use this modifier if the procedure required significantly more work than typically required. This could be due to factors such as increased intensity, time, technical difficulty, or severity of the patient's condition.
2. Modifier 50 (Bilateral Procedure):
- Apply this modifier if the procedure was performed on both sides of the body during the same operative session.
3. Modifier 51 (Multiple Procedures):
- Use this modifier when multiple procedures are performed during the same surgical session. It indicates that more than one procedure was performed, and it helps in the correct sequencing of the procedures.
4. Modifier 52 (Reduced Services):
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion. It indicates that the service provided was less extensive than described in the CPT code.
5. Modifier 59 (Distinct Procedural Service):
- Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is particularly important when procedures are not typically reported together but are appropriate under the circumstances.
6. Modifier 62 (Two Surgeons):
- Apply this modifier when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
7. Modifier 66 (Surgical Team):
- Use this modifier when a highly complex procedure requires the services of several physicians, often of different specialties, working together as a team.
8. Modifier 76 (Repeat Procedure by Same Physician):
- This modifier is used when the same procedure is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure.
9. Modifier 77 (Repeat Procedure by Another Physician):
- Apply this modifier when the same procedure is repeated by a different physician or other qualified healthcare professional subsequent to the original procedure.
10. 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 when a patient returns to the operating room for a related procedure during the postoperative period of the initial surgery.
11. 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.
12. Modifier 80 (Assistant Surgeon):
- Apply this modifier when an assistant surgeon is required to assist the primary surgeon during the procedure.
13. Modifier 81 (Minimum Assistant Surgeon):
- Use this modifier when a minimum assistant surgeon is required for the procedure.
14. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)):
- This modifier is used when an assistant surgeon is necessary, and a qualified resident surgeon is not available.
15. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery):
- Apply this modifier when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
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.
The CPT code 23125 is reimbursed by Medicare, but it is essential to verify its specific reimbursement rate and coverage criteria through the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered under Medicare Part B. Additionally, reimbursement can vary based on the policies of the Medicare Administrative Contractor (MAC) that services your geographic region. Each MAC may have unique guidelines and local coverage determinations (LCDs) that could affect the reimbursement process for CPT code 23125. Therefore, it is advisable to consult both the MPFS and your specific MAC for the most accurate and up-to-date information.
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 23125. Schedule a demo today to see how RevFind can help you identify and recover revenue from individual payers.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
