CPT code 23625 is for the closed treatment of a humeral tuberosity fracture with manipulation.
CPT code 23625 is used to describe the closed treatment of a humeral tuberosity fracture with manipulation. This means that a healthcare provider treats a fracture in the upper part of the arm bone (humerus) near the shoulder without making an incision, and they use manual techniques to properly align the bone fragments.
For CPT code 23625, which refers to the closed treatment of a humeral tuberosity fracture with 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. Documentation must support the substantial additional work and the reason for it.
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 the initial procedure, and the service 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 is performed by the same physician on the same day as the procedure.
4. Modifier 50 (Bilateral Procedure): Use this modifier if the procedure is performed bilaterally. This is less common for this specific code but may be applicable in certain clinical scenarios.
5. Modifier 51 (Multiple Procedures): Use this modifier if multiple procedures are performed during the same surgical session. This indicates that more than one procedure was performed.
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 started but 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 management portion of the procedure.
10. Modifier 56 (Preoperative Management Only): Use this modifier if the physician is providing only the preoperative management portion of the procedure.
11. 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.
12. Modifier 76 (Repeat Procedure or Service by Same Physician): Use this modifier if the procedure needs to be repeated by the same physician.
13. Modifier 77 (Repeat Procedure by Another Physician): Use this modifier if the procedure needs to be repeated by a different 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 requires an unplanned return 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 or service 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 AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Use this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist is assisting in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed and ensure accurate billing and reimbursement.
The CPT code 23625 is reimbursed by Medicare, but it is essential to verify its specific reimbursement rate and coverage 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 23625.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and identify underpayments down to the CPT code level, including specific codes like 23625. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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