CPT code 23525 is for the treatment of a sternoclavicular dislocation with manipulation.
CPT code 23525 is used to describe the closed treatment of a sternoclavicular dislocation with manipulation. This means that a healthcare provider has realigned a dislocated sternoclavicular joint (where the collarbone meets the sternum) without the need for surgical incision, using manual techniques to reposition the joint.
For CPT code 23525, which refers to the closed treatment of a sternoclavicular dislocation with manipulation, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier should be appended to indicate that it was a bilateral procedure.
3. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same surgical session, this modifier should be used to indicate that multiple procedures were carried out.
4. Modifier 52 - Reduced Services: If the procedure was partially reduced or eliminated at the physician's discretion, this modifier should be used to indicate that the service provided was less than usually required.
5. 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 often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure needs to be repeated by the same physician, this modifier should be used to indicate the repeat service.
7. Modifier 77 - Repeat Procedure by Another Physician: If the procedure is repeated by a different physician, this modifier should be used to indicate the repeat service by another provider.
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: This modifier is used when a patient returns to the operating room for a related procedure during the postoperative period of the initial procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier should be used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier should be appended to indicate the involvement of an assistant.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when a minimum assistant surgeon is 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.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and appropriate reimbursement.
The CPT code 23525 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 their corresponding reimbursement rates. Additionally, the final determination of reimbursement for CPT code 23525 may vary depending on the policies of the Medicare Administrative Contractor (MAC) for your region. MACs are responsible for processing Medicare claims and can provide further guidance on any regional variations or additional documentation requirements needed 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 23525. Ensure you're receiving the full reimbursement you deserve from every payer. Schedule a demo today to see RevFind in action and safeguard your revenue.
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
