CPT code 23480 is a medical code used to describe the surgical revision of the collar bone, ensuring accurate billing and documentation.
CPT code 23480 is used to describe the surgical procedure for the revision of the collar bone, also known as the clavicle. This code is specifically utilized when a previous surgery on the collar bone needs to be corrected or modified due to complications, improper healing, or other medical reasons. The revision process may involve the removal of hardware, realignment of the bone, or other necessary adjustments to ensure proper function and healing.
When billing for CPT code 23480 (Revision of collar bone), 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 23480, 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 revision of the collar bone was performed on both sides during the same operative session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures, other than E/M services, are performed at the same session by the same provider.
4. Modifier 52 - Reduced Services
- This modifier is appropriate 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
- Apply 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
- This modifier is used if the patient returns 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 occurs during the postoperative period.
10. Modifier LT - Left Side
- Use this modifier to specify that the procedure was performed on the left side of the body.
11. Modifier RT - Right Side
- Use this modifier to specify that the procedure was performed on the right side of the body.
12. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon is required for the procedure.
14. 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.
15. 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.
Proper use of these modifiers ensures that the billing accurately reflects the services provided, which can help in avoiding claim denials and ensuring appropriate reimbursement. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
The CPT code 23480 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. To determine the exact reimbursement rate, you should refer to the Medicare Physician Fee Schedule (MPFS), which provides detailed information on the payment rates for services covered by Medicare. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and can offer guidance on any regional variations or specific requirements for reimbursement. It is advisable to consult both the MPFS and your local MAC to ensure accurate and up-to-date information regarding the reimbursement of CPT code 23480.
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