CPT code 23460 is for the surgical repair of the shoulder capsule, addressing issues like instability or dislocation.
CPT code 23460 is used to describe a surgical procedure for repairing the shoulder capsule. This procedure typically involves the surgeon making necessary adjustments to the shoulder's connective tissue to restore stability and function. It is often performed to address issues such as shoulder dislocations or chronic instability, helping patients regain proper shoulder movement and reduce pain.
When billing for CPT code 23460 (Repair shoulder capsule), 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 23460, 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. Documentation must support the increased complexity.
2. Modifier 50 (Bilateral Procedure): Apply this modifier if the repair of the shoulder capsule 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. It indicates that the procedure is one of several performed.
4. Modifier 52 (Reduced Services): This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion. Documentation should support the reason for the reduction.
5. Modifier 59 (Distinct Procedural Service): Apply this modifier to indicate that the procedure is distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 76 (Repeat Procedure by Same Physician): Use this modifier if the same procedure is repeated by the same physician on the same day.
7. Modifier 77 (Repeat Procedure by Another Physician): Apply this modifier if the same procedure is repeated by a different physician on the same day.
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): Use this modifier if the patient requires an unplanned return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Apply this modifier if the procedure is unrelated to the original procedure and is performed during the postoperative period.
10. Modifier LT (Left Side): Use this modifier to specify that the procedure was performed on the left shoulder.
11. Modifier RT (Right Side): Apply 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): Use this modifier when a non-physician provider assists in the surgery.
Proper use of these modifiers ensures that claims are processed correctly and that healthcare providers receive appropriate reimbursement for their services. Always refer to the latest coding guidelines and payer-specific policies for the most accurate and up-to-date information.
CPT code 23460 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. To determine if this code is reimbursed under the Medicare Physician Fee Schedule (MPFS), healthcare providers should consult the MPFS database, which outlines the payment rates for services covered by Medicare. Additionally, it is essential to check with the relevant Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and can provide detailed information on coverage and reimbursement policies for CPT code 23460.
Discover how MD Clarity's RevFind software can read your contracts and detect underpayments down to the CPT code level and by individual payer. Ensure you're getting paid accurately for procedures like CPT code 23460. Schedule a demo today to see how RevFind can optimize your revenue cycle management.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
