CPT code 23190 is for the partial removal of the scapula, detailing the specific medical procedure for accurate billing and documentation.
CPT code 23190 is used to describe the partial removal of the scapula, which is the shoulder blade. This procedure involves surgically excising a portion of the scapula, typically to address conditions such as tumors, infections, or severe trauma that affect the shoulder blade. The goal is to remove the problematic area while preserving as much of the scapula's function and structure as possible.
When billing for CPT code 23190 (Partial removal of scapula), 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 23190, 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 increased complexity or unusual circumstances.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the partial removal of the scapula was performed on both sides 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 done, which may affect reimbursement.
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 than usually required.
5. Modifier 59 - Distinct Procedural Service
- Apply this modifier to indicate that the procedure was distinct or independent from other services performed on the same day. This is particularly useful when the procedures are not typically reported together but are appropriate under the circumstances.
6. Modifier 62 - Two Surgeons
- Use this modifier if two surgeons were required to perform the procedure together, each acting as a primary surgeon.
7. Modifier 66 - Surgical Team
- This modifier is used 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
- Apply this modifier if the same physician needs to repeat the procedure on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if a different physician repeats the procedure on the same day.
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
- This modifier is used when the patient needs to return to the operating room for a related procedure during the postoperative period.
11. 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.
12. Modifier 80 - Assistant Surgeon
- Use this modifier when an assistant surgeon is required to help with the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- This modifier is used when a minimum assistant surgeon is required for the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier 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
- Use this modifier when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
By appropriately applying these modifiers, healthcare providers can ensure accurate coding, billing, and reimbursement for the partial removal of the scapula procedure.
CPT code 23190 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. To determine if this code is reimbursed under the Medicare Physician Fee Schedule (MPFS), healthcare providers should consult the MPFS database, which outlines the payment rates for services covered by Medicare. Additionally, it is essential to check with the relevant Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and can provide detailed information on coverage and reimbursement policies for CPT code 23190. Always ensure that the service meets Medicare's medical necessity criteria and documentation requirements to secure reimbursement.
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 23190. Ensure you're receiving the full reimbursement you deserve from each payer. Schedule a demo today to see RevFind in action and protect your revenue.
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
