CPT code 23222 is for the partial removal of the humerus, a procedure involving the surgical excision of part of the upper arm bone.
CPT code 23222 is for the partial removal of the humerus, which is the upper arm bone. This procedure involves surgically removing a portion of the humerus, typically to address conditions such as tumors, infections, or severe fractures that cannot be treated through other means.
For CPT code 23222, which pertains to the partial removal of the humerus, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by another physician.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used when a related procedure is performed during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier LT - Left Side: Used to indicate that the procedure was performed on the left side of the body.
11. Modifier RT - Right Side: Used to indicate that the procedure was performed on the right side of the body.
12. Modifier 99 - Multiple Modifiers: Used when two or more modifiers are necessary to describe the service.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
CPT code 23222 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 payment rates for each CPT code. Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) are responsible for processing claims and setting local coverage determinations. Therefore, it is advisable to consult the relevant MAC for your area to confirm the exact reimbursement rate and any specific coverage criteria for CPT code 23222.
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