CPT code 23485 is for the surgical revision of the collar bone, often needed to correct previous procedures or address complications.
CPT code 23485 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 issues that necessitate a secondary surgical intervention. The revision procedure aims to restore proper function and alignment of the collar bone, ensuring better outcomes for the patient.
When billing for CPT code 23485 (Revision of collar bone), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and to provide additional information about the procedure. Below is a list of potential modifiers that could be used with CPT code 23485, 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. This could be due to the complexity of the revision or unexpected complications.
2. Modifier 50 - Bilateral Procedure
- If the revision of the collar bone is performed on both sides during the same surgical session, this modifier should be appended.
3. Modifier 51 - Multiple Procedures
- Apply this modifier if multiple procedures, including the revision of the collar bone, are performed during the same surgical session.
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
- This modifier is used to indicate that the revision of the collar bone was a distinct procedural service from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician
- If the same physician performs a repeat revision of the collar bone, this modifier should be used.
7. Modifier 77 - Repeat Procedure by Another Physician
- If a different physician performs a repeat revision of the collar bone, this modifier should be appended.
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 revision of the collar bone is performed during the postoperative period of another unrelated procedure.
10. Modifier LT - Left Side
- Use this modifier if the revision of the collar bone is performed on the left side.
11. Modifier RT - Right Side
- Use this modifier if the revision of the collar bone is performed on the right side.
12. Modifier 80 - Assistant Surgeon
- If an assistant surgeon is required for the procedure, this modifier should be used.
13. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon is required for the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier if an assistant surgeon is required because a qualified resident surgeon is not available.
15. 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 assists in the surgery.
By appropriately using these modifiers, healthcare providers can ensure that their claims for CPT code 23485 are accurately processed and reimbursed.
CPT code 23485 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. To determine if this particular CPT code is covered and the 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 by Medicare.
Additionally, it is essential to consult with your local Medicare Administrative Contractor (MAC). MACs are responsible for processing Medicare claims and can provide region-specific information regarding coverage and reimbursement for CPT code 23485. They can also offer guidance on any additional documentation or criteria that may be required for reimbursement.
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 23485. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and ensure you receive the full reimbursement you deserve.
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