CPT code 23552 is used for the open treatment of an acromioclavicular dislocation, acute or chronic, with or without graft.
CPT code 23552 is used to describe the surgical procedure for the open treatment of an acromioclavicular (AC) joint dislocation, specifically when it involves the use of an acute or chronic graft. This code is typically utilized when a healthcare provider performs surgery to repair a dislocated AC joint, which is the joint at the top of the shoulder where the collarbone (clavicle) meets the highest point of the shoulder blade (acromion). The procedure often involves the use of a graft to stabilize the joint and ensure proper healing.
When billing for CPT code 23552 (Open treatment of acromioclavicular dislocation, acute or chronic; with fascial graft (includes obtaining graft)), it is essential to consider the appropriate modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of potential modifiers that could be used with CPT code 23552, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more work than typically required. This could be due to the complexity of the patient's condition or other complicating factors.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both sides of the body during the same operative session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session. This helps indicate 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 59 - Distinct Procedural Service
- Apply this modifier to indicate that the procedure is distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 62 - Two Surgeons
- Use this modifier when two surgeons work together as primary surgeons performing distinct parts of the procedure.
7. Modifier 66 - Surgical Team
- Apply this modifier if the procedure requires the skills of a surgical team.
8. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same physician needs to repeat the procedure on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if a different physician repeats the procedure on the same day.
10. Modifier 78 - Unplanned Return to the Operating Room
- Use this modifier if the patient requires an unplanned return to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if the physician performs an unrelated procedure during the postoperative period of the initial procedure.
12. Modifier 80 - Assistant Surgeon
- Use this modifier when an assistant surgeon is required for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon is required.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier when an assistant surgeon is required, and a qualified resident surgeon is not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Apply this modifier when a non-physician provider assists in the surgery.
Each modifier serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement. Always refer to the latest coding guidelines and payer policies to confirm the correct use of modifiers.
The CPT code 23552 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 reimbursement rates. However, it is important to note that the final determination of reimbursement for CPT code 23552 may also depend on the policies of the Medicare Administrative Contractor (MAC) for your region. MACs are responsible for processing Medicare claims and can have localized policies that affect reimbursement. Therefore, it is advisable to consult the MPFS and your regional MAC to confirm the specific reimbursement details for CPT code 23552.
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