CPT code 23220 is a medical code used to describe the surgical procedure for resecting a tumor from the proximal humerus.
CPT code 23220 is used to describe the surgical procedure for the resection of a tumor located in the proximal humerus. This involves the removal of a tumor from the upper part of the arm bone near the shoulder. This code is utilized by healthcare providers to ensure accurate billing and documentation of the specific surgical intervention performed.
When billing for CPT code 23220 (Resect proximal humerus tumor), 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 23220, 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
- Apply this modifier if the procedure was performed on both the left and right proximal humerus during the same surgical 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
- Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion. Documentation should clearly explain the reduction in services.
5. Modifier 53 - Discontinued Procedure
- Use this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. 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 often used to bypass National Correct Coding Initiative (NCCI) edits.
7. Modifier 62 - Two Surgeons
- Use this modifier if two surgeons worked together as primary surgeons performing distinct parts of the procedure. Each surgeon should report their distinct operative work.
8. Modifier 66 - Surgical Team
- Apply this modifier if the procedure required the services of a surgical team due to its complexity.
9. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same physician performed the procedure more than once on the same day.
10. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if a different physician performed the procedure more than once on the same day.
11. Modifier 78 - Unplanned Return to the Operating Room
- Use this modifier if the patient required an unplanned return to the operating room for a related procedure during the postoperative period.
12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if the procedure was unrelated to the original surgery and was performed by the same physician during the postoperative period.
13. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was required to help perform the procedure.
14. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon was required for the procedure.
15. 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.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Apply this modifier if a non-physician practitioner assisted in the surgery.
Proper use of these modifiers ensures accurate billing and helps avoid claim denials or delays. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
The CPT code 23220 is reimbursed by Medicare, but it is essential to verify the specific details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and the corresponding reimbursement rates. Additionally, it is crucial to consult with your regional Medicare Administrative Contractor (MAC) to confirm the reimbursement status and any specific billing requirements or guidelines that may apply to CPT code 23220. Each MAC may have unique policies or interpretations that could impact reimbursement, so direct communication with your MAC is advisable for the most accurate and up-to-date information.
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