CPT code 23665 is for the closed treatment of a shoulder dislocation with a fracture of the greater humeral tuberosity.
CPT code 23665 is used to describe the closed treatment of a shoulder dislocation with a fracture of the greater humeral tuberosity. This procedure involves realigning the dislocated shoulder and addressing the fracture without the need for an open surgical incision.
When billing for CPT code 23665 (Closed treatment of shoulder dislocation with fracture of greater humeral tuberosity), 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. Documentation must support the substantial additional work.
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 for a reason 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 E/M 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 shoulders during the same session.
5. Modifier 51 - Multiple Procedures: Use this modifier if multiple procedures were performed during the same session.
6. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
7. Modifier 57 - Decision for Surgery: Use this modifier if the decision for surgery was made during the E/M service on the day before or the day of the procedure.
8. 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.
9. Modifier 76 - Repeat Procedure or Service by Same Physician: Use this modifier if the procedure had to be repeated by the same physician.
10. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the procedure had to be repeated by a different physician.
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: Use this modifier if the patient had to return to the operating room for a related procedure during the postoperative period.
12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if an unrelated procedure or service was performed by the same physician during the postoperative period.
13. Modifier 80 - Assistant Surgeon: Use this modifier if an assistant surgeon was required during the procedure.
14. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon was required during the procedure.
15. 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.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Use this modifier if a PA, NP, or CNS assisted in the surgery.
Each modifier serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement. Proper documentation is essential to support the use of any modifier.
CPT code 23665 is reimbursed by Medicare, but it is essential to verify the specific details through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, including the associated reimbursement rates. Additionally, MACs play a crucial role in processing Medicare claims and can offer region-specific guidance on reimbursement policies. Therefore, while CPT code 23665 is generally reimbursed, consulting the MPFS and your MAC will ensure accurate and up-to-date information tailored to your location.
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