CPT code 23505 is for the closed treatment of a clavicular fracture with manipulation.
CPT code 23505 is used to describe the closed treatment of a clavicular fracture with manipulation. This means that a healthcare provider treats a broken collarbone (clavicle) without the need for surgical incision, but with the use of manual techniques to properly align the bone fragments. This procedure is typically performed to ensure proper healing and restore function to the shoulder area.
When billing for CPT code 23505 (Closed treatment of clavicular fracture; with manipulation), the following modifiers may be applicable depending on the specific circumstances of the treatment:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. Documentation must support the substantial additional work.
2. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: Use this modifier if an unrelated E/M service is performed during the postoperative period of the initial procedure.
3. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: Use this modifier if a significant, separately identifiable E/M service is provided on the same day as the procedure.
4. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure is performed on both sides of the body.
5. Modifier 51 - Multiple Procedures: Use this modifier if multiple procedures are performed during the same session.
6. Modifier 52 - Reduced Services: Use this modifier if the procedure is partially reduced or eliminated at the physician's discretion.
7. Modifier 53 - Discontinued Procedure: Use this modifier if the procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
8. Modifier 54 - Surgical Care Only: Use this modifier if the physician is providing only the surgical care portion of the procedure.
9. Modifier 55 - Postoperative Management Only: Use this modifier if the physician is providing only the postoperative care.
10. Modifier 56 - Preoperative Management Only: Use this modifier if the physician is providing only the preoperative care.
11. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day.
12. Modifier 76 - Repeat Procedure or Service by Same Physician: Use this modifier if the same procedure is repeated by the same physician.
13. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the same procedure is repeated by a different physician.
14. 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 returns to the operating room for a related procedure during the postoperative period.
15. 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.
16. Modifier 80 - Assistant Surgeon: Use this modifier if an assistant surgeon is required for the procedure.
17. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon is required for the procedure.
18. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier if an assistant surgeon is required and a qualified resident surgeon is not available.
19. Modifier 99 - Multiple Modifiers: Use this modifier if multiple modifiers are applicable to the procedure.
Each modifier serves a specific purpose and should be used accurately to ensure proper billing and reimbursement. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
The CPT code 23505 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides a comprehensive list of the payment rates for services covered by Medicare, including CPT code 23505. However, the actual reimbursement amount can differ depending on the geographic location and the policies of the Medicare Administrative Contractor (MAC) that processes claims in your region. It's essential to consult the MPFS and your local MAC for precise reimbursement details for CPT code 23505.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 23505, RevFind provides unparalleled accuracy by individual payer. Schedule a demo today to see how RevFind can optimize your revenue cycle and safeguard your practice's financial health.
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
