CPT code 23655 is for the treatment of a shoulder dislocation with manipulation under anesthesia.
CPT code 23655 is used to describe the procedure of closed treatment of a shoulder dislocation with manipulation, performed under anesthesia. This code is typically used when a healthcare provider needs to realign a dislocated shoulder without making an incision, and the patient is given anesthesia to manage pain and ensure comfort during the procedure.
When billing for CPT code 23655 (Closed treatment of shoulder dislocation, with manipulation; requiring anesthesia), 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. 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): Used if an evaluation and management service provided during the 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 evaluation and management service is performed by the same physician on the same day as the procedure.
4. Modifier 50 (Bilateral Procedure): Used if the procedure is performed on both shoulders during the same session.
5. Modifier 51 (Multiple Procedures): Used when multiple procedures are performed during the same session. This modifier indicates that the procedure is one of several performed.
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 started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
8. 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.
9. Modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional): Used when a procedure or service is repeated by the same physician or other qualified healthcare professional.
10. Modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional): Used when a procedure or service is repeated by another physician or other qualified healthcare professional.
11. 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 of the initial procedure.
12. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Used when an unrelated procedure or service is performed by the same physician during the postoperative period.
13. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required during the procedure.
14. Modifier 81 (Minimum Assistant Surgeon): Used when a minimum assistant surgeon is required during the procedure.
15. 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.
16. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed and ensure accurate billing and reimbursement. Always ensure that the use of modifiers is supported by proper documentation in the patient's medical record.
CPT code 23655 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and the corresponding payment rates. Additionally, the reimbursement for CPT code 23655 may vary depending on the region, as Medicare Administrative Contractors (MACs) have the authority to interpret national policies and make local coverage determinations. Therefore, it is essential for healthcare providers to consult the MPFS and their respective MAC to ensure compliance and accurate reimbursement for CPT code 23655.
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