CPT code 23474 is for the revision and reconstruction of the shoulder joint, ensuring accurate billing for this specific surgical procedure.
CPT code 23474 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 surgery needs to be corrected or improved due to complications, failure of the initial surgery, or other issues that necessitate a secondary intervention. The procedure involves the surgeon making necessary adjustments or replacements to restore proper function and alleviate pain in the shoulder joint.
For CPT code 23474 (Revis reconst shoulder joint), the following modifiers may be applicable depending on the specific circumstances of the procedure:
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 increased complexity or time.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both shoulders during the same operative session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session. This helps indicate that more than one procedure was carried out.
4. Modifier 52 - Reduced Services
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure
- Apply this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. 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.
7. Modifier 62 - Two Surgeons
- This modifier is used when two surgeons work together as primary surgeons performing distinct parts of the procedure.
8. Modifier 66 - Surgical Team
- Apply this modifier if the procedure requires the expertise of a surgical team.
9. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same physician needs to repeat the procedure on the same day.
10. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used when a different physician repeats the procedure on the same day.
11. 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 needs to return to the operating room for a related procedure during the postoperative period.
12. 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 procedure.
13. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required for the procedure.
14. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon is required for the procedure.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier when an assistant surgeon is necessary because a qualified resident surgeon is not available.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used when a non-physician provider assists in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
CPT code 23474 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and the corresponding payment rates. However, it is essential to verify the reimbursement status with your local Medicare Administrative Contractor (MAC), as they are responsible for processing Medicare claims and can provide detailed information on any regional variations or additional requirements that may apply. Always consult the MPFS and your MAC to ensure accurate and up-to-date information regarding the reimbursement of CPT code 23474.
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