CPT code 23410 is a medical code used to describe the surgical repair of an acute rotator cuff injury.
CPT code 23410 is used to describe the surgical procedure for repairing an acute rotator cuff injury. This code is specifically assigned to the operation where the surgeon repairs a recently torn rotator cuff, which is a group of muscles and tendons that stabilize the shoulder. The procedure typically involves reattaching the torn tendons to the bone to restore shoulder function and alleviate pain.
When billing for CPT code 23410 (Repair of acute rotator cuff tear), 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 23410, 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 factors such as the complexity of the tear or patient-specific anatomical variations.
2. Modifier 50 (Bilateral Procedure)
- Apply this modifier if the rotator cuff repair was performed on both shoulders 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 the rotator cuff repair was one of several procedures.
4. Modifier 52 (Reduced Services)
- This modifier is appropriate if the procedure was partially reduced or eliminated at the physician's discretion. For example, if only a partial repair was performed due to patient-specific factors.
5. Modifier 59 (Distinct Procedural Service)
- Use this modifier to indicate that the rotator cuff repair was a distinct procedural service from other services performed on the same day. This is particularly important if other procedures were performed on the same shoulder but are not typically reported together.
6. Modifier 76 (Repeat Procedure by Same Physician)
- Apply this modifier if the same physician performed a repeat rotator cuff repair procedure on the same shoulder within a short period.
7. Modifier 77 (Repeat Procedure by Another Physician)
- Use this modifier if a different physician performed a repeat rotator cuff repair procedure on the same shoulder within a short period.
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)
- This modifier is used if the patient requires an unplanned return to the operating room for a related procedure during the postoperative period of the initial rotator cuff repair.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period)
- Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial rotator cuff repair.
10. Modifier LT (Left Side)
- Apply this modifier to specify that the procedure was performed on the left shoulder.
11. Modifier RT (Right Side)
- Use this modifier to specify that the procedure was performed on the right shoulder.
12. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery)
- This modifier is used 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 repair of an acute rotator cuff tear.
CPT code 23410 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides a comprehensive list of services covered by Medicare, including the associated reimbursement rates for each CPT code. To determine the exact reimbursement rate for CPT code 23410, healthcare providers should refer to the MPFS.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing Medicare claims and can provide region-specific information regarding the reimbursement of CPT code 23410. MACs may have local coverage determinations (LCDs) that affect whether and how this code is reimbursed in different regions. Therefore, it is advisable for healthcare providers to consult their respective MAC for detailed and localized reimbursement information for CPT code 23410.
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