CPT code 23462 is a medical code used to describe the surgical repair of the shoulder capsule.
CPT code 23462 is used to describe a surgical procedure for repairing the shoulder capsule. This code is specifically utilized when a surgeon performs a repair on the capsule of the shoulder joint, which may be necessary due to injuries, instability, or other conditions affecting the shoulder's function. The procedure aims to restore stability and proper movement to the shoulder by addressing issues within the capsule, which is the fibrous tissue surrounding the joint.
When billing for CPT code 23462 (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 modifiers that could be used with CPT code 23462, 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 operative session.
3. Modifier 51 (Multiple Procedures):
- Use this modifier when multiple procedures, including 23462, are performed during the same surgical session. This helps indicate that more than one procedure was performed.
4. Modifier 59 (Distinct Procedural Service):
- This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day. It helps to avoid bundling issues.
5. Modifier 76 (Repeat Procedure by Same Physician):
- Use this modifier if the same physician needs to repeat the procedure on the same day.
6. Modifier 77 (Repeat Procedure by Another Physician):
- Apply this modifier if a different physician repeats the procedure on the same day.
7. 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.
8. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period):
- Apply this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier LT (Left Side):
- Use this modifier to specify that the procedure was performed on the left shoulder.
10. Modifier RT (Right Side):
- Apply this modifier to indicate that the procedure was performed on the right shoulder.
11. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery):
- Use this modifier when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
12. Modifier GC (Service Performed in Part by a Resident Under the Direction of a Teaching Physician):
- Apply this modifier when a resident performs the service under the supervision of a teaching physician.
13. Modifier QX (CRNA Service with Medical Direction by a Physician):
- Use this modifier if a Certified Registered Nurse Anesthetist (CRNA) provides anesthesia services under the medical direction of a physician.
14. Modifier QY (Medical Direction of One CRNA by an Anesthesiologist):
- Apply this modifier when an anesthesiologist provides medical direction for one CRNA.
15. Modifier QK (Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures Involving Qualified Individuals):
- Use this modifier if an anesthesiologist is directing two to four concurrent anesthesia procedures.
Correctly applying these modifiers ensures that the billing accurately reflects the services provided, which is crucial for proper reimbursement and compliance with payer policies. Always refer to the latest coding guidelines and payer-specific requirements when using modifiers.
CPT code 23462 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. To determine if CPT 23462 is covered and the exact reimbursement rate, healthcare providers should refer to 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 essential to consult with the respective Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and can provide region-specific guidance on coverage and reimbursement for CPT 23462.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 23462. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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