CPT code 23412 is a medical code used to describe the surgical repair of a chronic rotator cuff injury.
CPT code 23412 is used to describe the surgical procedure for repairing a chronic rotator cuff injury. This code is specifically assigned to the operation where a surgeon addresses long-standing damage to the 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, often using sutures or anchors, to restore shoulder function and alleviate pain. This code is crucial for accurate billing and ensures that healthcare providers are reimbursed appropriately for the complexity and resources involved in this type of surgery.
When billing for CPT code 23412 (Repair of rotator cuff, chronic), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of modifiers that could be used with CPT code 23412, 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 for the repair of a chronic rotator cuff.
2. Modifier -50 (Bilateral Procedure)
- Apply this modifier if the repair of the rotator cuff was performed on both shoulders during the same surgical session.
3. Modifier -51 (Multiple Procedures)
- Use this modifier when multiple procedures, other than E/M services, are performed by the same provider during the same session. This helps indicate that multiple distinct procedures were carried out.
4. Modifier -52 (Reduced Services)
- Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier -59 (Distinct Procedural Service)
- Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day. This is particularly useful if another procedure was performed on the same shoulder but at a different site or through a different incision.
6. Modifier -62 (Two Surgeons)
- Apply this modifier if two surgeons were required to perform the procedure together, each acting as a primary surgeon for a distinct part of the surgery.
7. Modifier -66 (Surgical Team)
- Use this modifier if the procedure required a highly complex surgical team approach, involving multiple surgeons with different specialties.
8. Modifier -76 (Repeat Procedure by Same Physician)
- Apply this modifier if the same physician performed the procedure again within a short period due to complications or other reasons.
9. Modifier -77 (Repeat Procedure by Another Physician)
- Use this modifier if a different physician performed the procedure again within a short period due to complications or other reasons.
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)
- Apply this modifier if the patient had 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)
- Use this modifier if an unrelated procedure was performed by the same physician during the postoperative period of the initial surgery.
12. Modifier -80 (Assistant Surgeon)
- Apply this modifier if an assistant surgeon was necessary to complete the procedure.
13. Modifier -81 (Minimum Assistant Surgeon)
- Use this modifier if a minimum assistant surgeon was required for the procedure.
14. Modifier -82 (Assistant Surgeon (when qualified resident surgeon not available))
- Apply this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.
15. Modifier -AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery)
- Use this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted in the surgery.
By appropriately applying these modifiers, healthcare providers can ensure that their claims for CPT code 23412 are accurately represented and reimbursed.
The CPT code 23412 is reimbursed by Medicare, but it is essential to verify its specific reimbursement rate and coverage criteria through the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered under Medicare Part B. Additionally, it is crucial to consult with your regional Medicare Administrative Contractor (MAC) to ensure that the code is covered and to understand any local coverage determinations (LCDs) that may apply. The MACs are responsible for processing Medicare claims and can provide guidance on any documentation or billing requirements specific to CPT code 23412.
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