CPT code 23172 is a medical code used to describe the procedure for removing a lesion from the shoulder blade.
CPT code 23172 is used to describe the surgical procedure for the removal of a lesion from the shoulder blade (scapula). This code is specifically assigned to indicate that a healthcare provider has performed an excision to remove an abnormal growth or mass from the shoulder blade area.
When billing for CPT code 23172 (Remove shoulder blade lesion), it is important to consider the use of appropriate modifiers to ensure accurate reimbursement and to provide additional information about the procedure. Below is a list of potential modifiers that could be used with CPT code 23172, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort or complexity than typically required. Documentation must support the increased effort.
2. Modifier 50 - Bilateral Procedure
- Use this modifier if the procedure was performed on both shoulders during the same session.
3. Modifier 51 - Multiple Procedures
- Use this modifier if multiple procedures were performed during the same surgical session. This helps to indicate that more than one procedure was done.
4. 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 if another procedure was performed on a different site or through a separate incision.
5. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same procedure was repeated by the same physician on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if the same procedure was repeated by a different physician on the same day.
7. Modifier 78 - Unplanned Return to the Operating Room
- Use this modifier if the patient had 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
- Use this modifier if an unrelated procedure was performed by the same physician during the postoperative period of the initial procedure.
9. Modifier LT - Left Side
- Use this modifier to specify that the procedure was performed on the left shoulder.
10. Modifier RT - Right Side
- Use this modifier to specify that the procedure was performed on the right shoulder.
11. Modifier 99 - Multiple Modifiers
- Use this modifier if more than four modifiers are necessary to describe the procedure accurately.
By using the appropriate modifiers, healthcare providers can ensure that their claims are processed correctly and that they receive accurate reimbursement for the services provided. Always ensure that the documentation supports the use of any modifiers to avoid claim denials or delays.
CPT code 23172 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered by Medicare, including CPT code 23172. However, the final determination of reimbursement is often made by the Medicare Administrative Contractor (MAC) for your specific region. MACs are responsible for processing Medicare claims and can provide detailed information on coverage and reimbursement rates for CPT code 23172. It is advisable to consult the MPFS and your regional MAC to get precise information on the reimbursement for this code.
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