CPT code 23630 is for the open treatment of a humeral tuberosity fracture, including internal fixation, if performed.
CPT code 23630 is used to describe the surgical procedure for the open treatment of a humeral tuberosity fracture with internal fixation. This means that a surgeon makes an incision to access the fractured area of the upper arm bone (humerus) and uses hardware, such as screws or plates, to stabilize and fix the broken bone fragments. This procedure is typically performed to ensure proper healing and restore function to the shoulder and arm.
For CPT code 23630 (Open treatment of humeral shaft fracture, with internal fixation), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required.
2. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: Used when an evaluation and management service performed during a postoperative period 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: Used when a significant, separately identifiable E/M service is performed by the same physician on the same day as the procedure.
4. Modifier 50 - Bilateral Procedure: Used when the same procedure is performed on both sides of the body.
5. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed at the same session by the same provider.
6. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
7. Modifier 53 - Discontinued Procedure: Used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
8. Modifier 54 - Surgical Care Only: Used when one physician performs the surgical care and another provides preoperative and/or postoperative management.
9. Modifier 55 - Postoperative Management Only: Used when one physician provides only the postoperative care.
10. Modifier 56 - Preoperative Management Only: Used when one physician provides only the preoperative care.
11. Modifier 57 - Decision for Surgery: Used when an E/M service results in the initial decision to perform surgery.
12. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: Used when a subsequent procedure is planned or anticipated.
13. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
14. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
15. Modifier 76 - Repeat Procedure or Service by Same Physician: Used when a procedure or service is repeated by the same physician.
16. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician.
17. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used when a related procedure is performed during the postoperative period.
18. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed during the postoperative period.
19. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
20. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
21. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required and a qualified resident surgeon is not available.
22. Modifier 99 - Multiple Modifiers: Used when more than four modifiers are necessary to describe the service.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 23630 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 respective reimbursement rates. Additionally, it is crucial to consult with your regional Medicare Administrative Contractor (MAC) to confirm any local coverage determinations or specific billing requirements that may apply to CPT code 23630. Each MAC may have unique guidelines and policies that could impact the reimbursement process.
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