CPT code 23545 is for the treatment of an acromioclavicular dislocation with manipulation under anesthesia.
CPT code 23545 is used to describe the surgical treatment of an acromioclavicular (AC) joint dislocation with the use of a muscle or tendon graft. This procedure typically involves the realignment and stabilization of the AC joint, which is located at the top of the shoulder where the collarbone (clavicle) meets the highest point of the shoulder blade (acromion). The use of a muscle or tendon graft helps to reinforce the joint and ensure proper healing and function.
When billing for CPT code 23545 (Closed treatment of acromioclavicular dislocation; with manipulation), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of potential modifiers that could be used with CPT code 23545, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort than typically required. Documentation must support the increased complexity.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both sides of the body during the same session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
4. Modifier 52 - Reduced Services
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure
- Apply this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 54 - Surgical Care Only
- Use this modifier when the physician performs the surgical procedure but does not provide preoperative or postoperative care.
7. Modifier 55 - Postoperative Management Only
- This modifier is used when the physician provides only the postoperative care.
8. Modifier 56 - Preoperative Management Only
- Apply this modifier when the physician provides only the preoperative care.
9. 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.
10. Modifier 76 - Repeat Procedure or Service by Same Physician
- This modifier is used when the same physician repeats the procedure or service.
11. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier when a procedure or service is repeated by another physician.
12. 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 requires an unplanned return to the operating room for a related procedure during the postoperative period.
13. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
14. Modifier 80 - Assistant Surgeon
- Apply this modifier when an assistant surgeon is required for the procedure.
15. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier when a minimum assistant surgeon is required.
16. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
17. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Apply this modifier when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
Proper use of these modifiers ensures accurate billing and helps avoid claim denials or delays. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
The CPT code 23545 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates. Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) may have localized policies and fee schedules. Therefore, it is advisable to consult the relevant MAC for your area to obtain precise information regarding the reimbursement for CPT code 23545.
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