CPT code 23585 is for the surgical repair of a scapular fracture with internal fixation, ensuring proper alignment and healing of the shoulder blade.
CPT code 23585 is used to describe the surgical procedure for the open treatment of a scapular fracture, which includes internal fixation. This means that a surgeon makes an incision to access the fractured scapula (shoulder blade) and uses hardware, such as plates or screws, to stabilize and fix the broken bone. This procedure is typically necessary when the fracture is complex or displaced, requiring precise alignment and stabilization to ensure proper healing and function.
For CPT code 23585 (Open treatment of scapular fracture with internal fixation), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly greater effort than typically required.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both scapulae, this modifier should be appended.
3. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier should be used.
4. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
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.
6. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure, this modifier should be appended.
7. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same procedure is repeated by the same physician.
8. Modifier 77 - Repeat Procedure by Another Physician: If the procedure is repeated by a different physician, this modifier should be used.
9. 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 if the patient needs to return to the operating room for a related procedure during the postoperative period.
10. 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.
11. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required, this modifier should be appended.
12. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon is required.
13. 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.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Use this modifier when these non-physician practitioners assist in the surgery.
15. Modifier LT - Left Side: If the procedure is performed on the left scapula, this modifier should be used.
16. Modifier RT - Right Side: If the procedure is performed on the right scapula, this modifier should be used.
These modifiers help provide additional information about the circumstances of the procedure, ensuring accurate billing and reimbursement.
The CPT code 23585 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC). The MPFS provides detailed information on the reimbursement rates and guidelines for various CPT codes, including 23585. Additionally, MACs may have localized policies or additional requirements that could impact reimbursement. Therefore, healthcare providers should consult both the MPFS and their respective MAC to ensure accurate and up-to-date information regarding the reimbursement of CPT code 23585.
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