CPT code 23155 is for the surgical removal of a lesion from the humerus, the bone of the upper arm.
CPT code 23155 is used for the surgical procedure involving the removal of a lesion from the humerus, which is the bone of the upper arm. This code is specifically assigned to indicate that a healthcare provider has performed an operation to excise or remove an abnormal growth or lesion from this particular bone. This procedure is typically done to address issues such as tumors, cysts, or other abnormal tissue that may be causing pain, dysfunction, or other health concerns in the patient.
For CPT code 23155, which pertains to the removal of a humerus lesion, the following modifiers may be applicable:
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 humeri during the same operative session.
3. Modifier 51 - Multiple Procedures: Use this modifier when multiple procedures are performed during the same surgical session. This indicates that the removal of the humerus lesion was one of several procedures.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the removal of the humerus lesion was a distinct service from other procedures performed on the same day. It is used to avoid bundling issues.
5. Modifier 76 - Repeat Procedure by Same Physician: Apply this modifier if the same physician needs to repeat the removal of a humerus lesion within a short period due to complications or recurrence.
6. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if a different physician needs to repeat the removal of a humerus lesion within a short period.
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 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: Apply this modifier if the removal of the humerus lesion is performed during the postoperative period of another, unrelated procedure.
9. Modifier LT - Left Side: Use this modifier to specify that the procedure was performed on the left humerus.
10. Modifier RT - Right Side: Use this modifier to specify that the procedure was performed on the right humerus.
11. Modifier 99 - Multiple Modifiers: If more than four modifiers are necessary to describe the procedure, use this modifier to indicate that multiple modifiers are applicable.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 23155 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, including the associated payment rates. Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) are responsible for processing claims and determining coverage specifics within their jurisdictions. Therefore, healthcare providers should consult their local MAC for precise information regarding the reimbursement of CPT code 23155.
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