CPT code 23575 is for the treatment of a scapula fracture with or without manipulation and traction.
CPT code 23575 is used to describe the closed treatment of a scapular fracture with manipulation, with or without the application of traction. This code is specifically for procedures where the scapula, or shoulder blade, is fractured and the treatment involves realigning the bone without making an incision. The manipulation may include the use of traction to help set the bone properly. This code is essential for accurately documenting and billing for this specific type of orthopedic treatment.
When billing for CPT code 23575 (Closed treatment of scapular fracture; with manipulation, with or without skeletal traction), 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 23575, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort or complexity than typically required.
2. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period
- Use this modifier if an evaluation and management service was performed during the postoperative period of another procedure, and it is unrelated to the original 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 evaluation and management service was provided on the same day as the procedure.
4. Modifier 50 - Bilateral Procedure
- Use this modifier if the procedure was performed on both sides of the body.
5. Modifier 51 - Multiple Procedures
- Use this modifier if multiple procedures were performed during the same surgical session.
6. Modifier 52 - Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
7. Modifier 53 - Discontinued Procedure
- Use this modifier if the procedure was discontinued due to extenuating circumstances or those that threatened the well-being of the patient.
8. Modifier 54 - Surgical Care Only
- Use this modifier if the physician provided only the surgical care portion of the procedure.
9. Modifier 55 - Postoperative Management Only
- Use this modifier if the physician provided only the postoperative care.
10. Modifier 56 - Preoperative Management Only
- Use this modifier if the physician provided only the preoperative care.
11. Modifier 57 - Decision for Surgery
- Use this modifier if an evaluation and management service resulted in the initial decision to perform the surgery.
12. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if the procedure was planned or anticipated (staged), more extensive than the original procedure, or for therapy following a surgical procedure.
13. Modifier 59 - Distinct Procedural Service
- Use this modifier if a procedure or service was distinct or independent from other services performed on the same day.
14. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Use this modifier if the same procedure was repeated by the same physician.
15. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Use this modifier if the same procedure was repeated by a different physician.
16. 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 required an unplanned return to the operating room for a related procedure during the postoperative period.
17. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if an unrelated procedure was performed by the same physician during the postoperative period.
18. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was required during the procedure.
19. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon was required during the procedure.
20. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.
21. 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 reflect the circumstances of the procedure accurately. Proper use of modifiers can help ensure that claims are processed correctly and that providers receive appropriate reimbursement for their services.
The CPT code 23575 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, it is advisable to consult with your regional Medicare Administrative Contractor (MAC) to confirm any local coverage determinations or specific billing requirements that may affect reimbursement for CPT code 23575.
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