CPT code 23520 is for the closed treatment of a sternoclavicular dislocation without manipulation.
CPT code 23520 is used to describe the closed treatment of a sternoclavicular dislocation without manipulation. This means that the healthcare provider addresses the dislocation of the joint where the sternum (breastbone) meets the clavicle (collarbone) without the need for physically adjusting or realigning the bones. This procedure typically involves methods such as immobilization or the use of a sling to allow the joint to heal naturally.
When billing for CPT code 23520 (Closed treatment of sternoclavicular dislocation; without manipulation), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more effort or time than typically required.
2. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: Apply 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 bilaterally.
5. Modifier 51 - Multiple Procedures: Apply 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: Apply 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: Apply 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: Apply this modifier if the procedure is 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 procedure is repeated by the same physician.
13. Modifier 77 - Repeat Procedure by Another Physician: Apply this modifier if the 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: Apply this modifier if an unrelated procedure is performed 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: Apply this modifier if a minimum assistant surgeon is required.
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: Apply this modifier if multiple modifiers are necessary for the procedure.
These modifiers help provide additional information about the circumstances of the procedure and ensure accurate billing and reimbursement. Always refer to the latest CPT and payer guidelines to confirm the appropriate use of modifiers.
The CPT code 23520 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and the corresponding payment rates. Additionally, the reimbursement for CPT code 23520 may vary depending on the region, as Medicare Administrative Contractors (MACs) have the authority to interpret national policies and establish local coverage determinations. Therefore, it is essential to consult the relevant MAC for your region to confirm the specific reimbursement details and any additional requirements for CPT code 23520.
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