CPT code 23195 is for the surgical removal of the head of the humerus, typically performed to treat severe shoulder conditions.
CPT code 23195 is used for the surgical procedure involving the removal of the head of the humerus. This code is typically utilized when a patient requires the excision of the upper part of the arm bone, often due to severe injury, arthritis, or other medical conditions that affect the shoulder joint. The procedure aims to alleviate pain and improve mobility by removing the damaged or diseased portion of the humerus.
For CPT code 23195 (Removal of head of humerus), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly greater effort than typically required. This could be due to complications or other factors that made the surgery more complex.
2. Modifier 50 - Bilateral Procedure: If the procedure was performed on both shoulders during the same surgical session, this modifier should be appended.
3. Modifier 51 - Multiple Procedures: If multiple procedures were performed during the same surgical session, this modifier should be used to indicate that 23195 was one of several procedures.
4. Modifier 59 - Distinct Procedural Service: Use this modifier if the removal of the head of the humerus was distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician: If the procedure had to be repeated by the same physician, this modifier should be appended.
6. Modifier 77 - Repeat Procedure by Another Physician: If the procedure had to be repeated by a different physician, this modifier should be used.
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 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: If the procedure was unrelated to the original surgery and occurred during the postoperative period, this modifier should be used.
9. Modifier LT - Left Side: If the procedure was performed on the left shoulder, this modifier should be appended.
10. Modifier RT - Right Side: If the procedure was performed on the right shoulder, this modifier should be appended.
11. Modifier 80 - Assistant Surgeon: If an assistant surgeon was necessary for the procedure, this modifier should be used.
12. Modifier 81 - Minimum Assistant Surgeon: If a minimum assistant surgeon was necessary, this modifier should be appended.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier if an assistant surgeon was necessary because a qualified resident surgeon was not available.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: If a PA, NP, or CNS assisted in the surgery, this modifier should be used.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 23195 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC). The MPFS provides detailed information on the reimbursement rates for various CPT codes, while the MACs offer localized guidance and can confirm if there are any specific conditions or limitations for reimbursement in your area. Always consult these resources to ensure accurate and up-to-date information regarding the reimbursement status of CPT code 23195.
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