CPT code 23490 is a medical code used to describe the procedure for reinforcing the clavicle.
CPT code 23490 is used to describe the surgical procedure for reinforcing the clavicle. This typically involves the use of hardware, such as plates or screws, to stabilize and strengthen the clavicle bone, often after a fracture or other injury. This code is essential for accurate billing and documentation of the specific surgical intervention performed to ensure proper healing and function of the clavicle.
When billing for CPT code 23490 (Reinforce clavicle), 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 23490, 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 procedure was performed on both clavicles 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 done.
4. Modifier 52 - Reduced Services
- This modifier is used if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service
- Apply 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
- This modifier is used 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
- Apply this modifier if the patient required 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
- Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon was required for the procedure.
12. 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.
13. 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.
14. Modifier LT - Left Side
- Apply this modifier if the procedure was performed on the left clavicle.
15. Modifier RT - Right Side
- Use this modifier if the procedure was performed on the right clavicle.
Proper use of these modifiers ensures that claims are processed correctly and that healthcare providers receive appropriate reimbursement for their services. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
The CPT code 23490 is reimbursed by Medicare, but it is essential to verify its specific reimbursement rate and coverage details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of fees that Medicare pays for each service, and it is updated annually to reflect changes in policy and reimbursement rates. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining local coverage decisions and processing claims. Therefore, it is advisable to consult the relevant MAC for your region to ensure that CPT code 23490 is covered and to understand any specific documentation or billing requirements that may apply.
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