CPT code 23130 is a medical code used to describe the surgical procedure for removing a part of the shoulder bone.
CPT code 23130 is used to describe the surgical procedure for the removal of a part of the shoulder bone. This code is typically utilized when a surgeon needs to excise a portion of the bone in the shoulder area, often due to conditions such as bone spurs, tumors, or other abnormalities that may be causing pain or impairing function. The procedure aims to alleviate symptoms and improve the range of motion and overall functionality of the shoulder joint.
When billing for CPT code 23130 (Remove shoulder bone part), 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 23130, 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. Documentation must support the increased complexity.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both shoulders during the same operative session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session. This helps indicate that more than one procedure was carried out.
4. Modifier 59 - Distinct Procedural Service
- This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
5. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same procedure is repeated by the same physician on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if the 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
- This modifier is used when the patient requires a 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
- Use this modifier if the procedure is unrelated to the original surgery and is performed during the postoperative period.
9. Modifier LT - Left Side
- Apply this modifier to indicate that the procedure was performed on the left shoulder.
10. Modifier RT - Right Side
- Use this modifier to indicate that the procedure was performed on the right shoulder.
11. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
12. Modifier GC - This Service Has Been Performed in Part by a Resident Under the Direction of a Teaching Physician
- Use this modifier when a resident performs part of the procedure under the supervision of a teaching physician.
By appropriately applying these modifiers, healthcare providers can ensure accurate coding, billing, and reimbursement for CPT code 23130. Always refer to the latest coding guidelines and payer-specific requirements for the most accurate and up-to-date information.
The CPT code 23130 is reimbursed by Medicare, but it is essential to verify its inclusion in the Medicare Physician Fee Schedule (MPFS) for the specific year in question. The MPFS outlines the payment rates for services provided by physicians and other healthcare professionals to Medicare beneficiaries. Additionally, reimbursement can vary based on the local coverage determinations (LCDs) set by the Medicare Administrative Contractor (MAC) for your region. Therefore, it is advisable to consult the MPFS and your regional MAC to confirm the current reimbursement status and any specific billing requirements for CPT code 23130.
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