CPT code 23145 is a medical code used to describe the procedure for the removal of a bone lesion.
CPT code 23145 is used to describe the surgical procedure for the removal of a bone lesion from the shoulder area. This code is specifically utilized when a surgeon excises or cuts out an abnormal growth or mass from the bone, ensuring that the lesion is completely removed to prevent further complications. This procedure is often necessary to diagnose the nature of the lesion, whether benign or malignant, and to alleviate any associated symptoms or risks.
When billing for CPT code 23145 (Removal of bone lesion), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of modifiers that could be used with CPT code 23145, 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 complexity, time, or effort.
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. This helps indicate that more than one procedure was carried out.
4. Modifier 52 (Reduced Services):
- This modifier is appropriate if the procedure was partially reduced or eliminated at the physician's discretion.
5. 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 when procedures are not typically reported together but are appropriate under the circumstances.
6. Modifier 76 (Repeat Procedure by Same Physician):
- Apply this modifier if the same procedure was repeated by the same physician on the same day.
7. Modifier 77 (Repeat Procedure by Another Physician):
- Use this modifier if the same procedure was repeated by a different physician on the same day.
8. 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 an unplanned return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period):
- Apply this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier LT (Left Side):
- Use this modifier to specify that the procedure was performed on the left side of the body.
11. Modifier RT (Right Side):
- Use this modifier to specify that the procedure was performed on the right side of the body.
12. Modifier 99 (Multiple Modifiers):
- This modifier is used when two or more modifiers are necessary to describe the service provided accurately.
By appropriately applying these modifiers, healthcare providers can ensure that their claims for CPT code 23145 are processed correctly, leading to accurate reimbursement and compliance with payer guidelines.
CPT code 23145 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, along with the corresponding reimbursement rates. However, it is important to note that the final determination of reimbursement for CPT code 23145 may also depend on the guidelines and policies set forth by the Medicare Administrative Contractor (MAC) in your specific region. MACs are responsible for processing Medicare claims and can have localized policies that affect reimbursement. Therefore, it is advisable to consult the MPFS and your regional MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 23145.
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