CPT code 23515 is for the open treatment of a clavicular fracture with internal fixation, a surgical procedure to repair a broken collarbone.
CPT code 23515 is used to describe the surgical procedure for the open treatment of a clavicular fracture, which includes internal fixation. This means that a surgeon makes an incision to access the broken clavicle (collarbone) and uses hardware, such as plates, screws, or rods, to stabilize and fix the fracture, ensuring proper alignment and healing.
For CPT code 23515, which pertains to the open treatment of a clavicular fracture with internal fixation, the following modifiers may be applicable:
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 intensity, time, technical difficulty, severity of the patient's condition, or physical and mental effort required.
2. Modifier 51 (Multiple Procedures): Apply this modifier if multiple procedures were performed during the same surgical session. This helps in indicating that more than one procedure was carried out.
3. Modifier 52 (Reduced Services): Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion. This could be due to patient-specific circumstances that necessitated a less extensive procedure.
4. Modifier 59 (Distinct Procedural Service): This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is particularly useful when procedures are not typically reported together but are appropriate under the circumstances.
5. Modifier 76 (Repeat Procedure by Same Physician): Apply this modifier if the same procedure was repeated by the same physician or other qualified healthcare professional subsequent to the original procedure.
6. Modifier 77 (Repeat Procedure by Another Physician): Use this modifier if the same procedure was repeated by a different physician or other qualified healthcare professional subsequent to the original procedure.
7. 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 when a patient requires a return to the operating room for a related procedure during the postoperative period of the initial surgery.
8. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Apply this modifier if an unrelated procedure or service is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier 80 (Assistant Surgeon): Use this modifier if an assistant surgeon was required during the procedure.
10. Modifier 81 (Minimum Assistant Surgeon): Apply this modifier if a minimum assistant surgeon was required during the procedure.
11. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Use this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.
12. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement for the services provided.
The CPT code 23515 is reimbursed by Medicare, but it is essential to verify its inclusion in the Medicare Physician Fee Schedule (MPFS) to determine the specific reimbursement rate. The MPFS provides a comprehensive list of services covered by Medicare and their corresponding payment amounts. Additionally, it is crucial to consult with your regional Medicare Administrative Contractor (MAC) to confirm any local coverage determinations or specific billing requirements that may affect reimbursement for CPT code 23515. Each MAC may have unique guidelines and policies that influence how this code is processed and reimbursed.
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