CPT code 23473 is for the revision and reconstruction of the shoulder joint.
CPT code 23473 is used to describe the surgical procedure for the revision and reconstruction of the shoulder joint. This code is typically utilized when a previous shoulder joint replacement or reconstruction has failed or requires modification. The procedure involves correcting or replacing components of the shoulder joint to restore its function and alleviate pain. This can include addressing issues such as loosening, wear, or infection of the joint prosthesis.
When billing for CPT code 23473 (Revision of total shoulder arthroplasty, including allograft when performed; humeral or glenoid component), it is essential to consider the appropriate modifiers to ensure accurate reimbursement and compliance. Below is a list of potential modifiers that could be used with CPT code 23473, 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
- Use this modifier if the procedure was performed on both shoulders during the same operative session.
3. Modifier 51 - Multiple Procedures
- Use this modifier if multiple procedures were performed during the same surgical session. This helps indicate that more than one procedure was performed.
4. Modifier 52 - Reduced Services
- Use 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.
6. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same procedure was repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if the same procedure was 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 had to 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
- Use this modifier if an unrelated procedure was performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon was required during the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.
13. 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.
It is crucial to review payer-specific guidelines and documentation requirements when applying these modifiers to ensure proper billing and reimbursement.
The CPT code 23473 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC). The MPFS provides detailed information on the reimbursement rates for various CPT codes, including 23473, and can help determine the allowable amount. Additionally, your MAC can offer guidance on any regional variations or specific requirements that may impact reimbursement for this code. Always ensure to check both resources to confirm the most accurate and up-to-date information regarding Medicare reimbursement for CPT code 23473.
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 23473. Ensure you're receiving the full reimbursement you deserve from every payer. Schedule a demo today to see RevFind in action and protect your revenue.
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
