CPT code 23540 is for the treatment of an acromioclavicular dislocation without the need for manipulation.
CPT code 23540 is used to describe the closed treatment of an acromioclavicular (AC) joint dislocation without the need for manipulation. This procedure involves realigning the dislocated AC joint, which connects the collarbone (clavicle) to the shoulder blade (acromion), without physically manipulating the bones back into place. This code is typically used when the dislocation can be managed through non-invasive methods such as immobilization or supportive devices.
For CPT code 23540 (Closed treatment of acromioclavicular dislocation; without 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.
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 another 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 surgical 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 portion of the procedure.
10. Modifier 56 - Preoperative Management Only: Use this modifier if the physician is providing only the preoperative care portion of the procedure.
11. Modifier 59 - Distinct Procedural Service: Use this modifier if a procedure or service 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: Use this modifier if the procedure is repeated by another 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 necessary to describe the service provided.
Each modifier serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
CPT code 23540 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, along with the corresponding reimbursement rates. To determine the exact reimbursement for CPT code 23540, healthcare providers should consult the MPFS for the current year.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide region-specific information regarding coverage and reimbursement for CPT code 23540. It is advisable for healthcare providers to check with their respective MAC to ensure compliance with local coverage determinations and any additional documentation requirements that may apply.
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