CPT code 23675 is used for the closed treatment of a shoulder dislocation with a neck fracture, including manipulation.
CPT code 23675 is used to describe the closed treatment of a shoulder dislocation with a neck fracture, including manipulation. This means that the procedure involves realigning the dislocated shoulder and addressing the associated neck fracture without the need for surgical incision. The manipulation aspect refers to the manual adjustment performed by the healthcare provider to ensure proper alignment and healing.
When billing for CPT code 23675 (Closed treatment of shoulder dislocation with fracture of greater humeral tuberosity; with manipulation), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of potential modifiers that could be used with CPT code 23675, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more work than typically required. Documentation must support the increased complexity.
2. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period
- Use this modifier if an evaluation and management (E/M) service was performed during the postoperative period of the initial procedure and 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 an E/M service was provided on the same day as the procedure and is distinct and separately identifiable from 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 surgical session. This helps indicate that the procedure is one of several 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 performed the surgical procedure but did not provide preoperative or postoperative care.
9. Modifier 55 - Postoperative Management Only
- Use this modifier if the physician provided only the postoperative care for the procedure.
10. Modifier 56 - Preoperative Management Only
- Use this modifier if the physician provided only the preoperative care for the procedure.
11. Modifier 59 - Distinct Procedural Service
- Use this modifier if the procedure was distinct or independent from other services performed on the same day.
12. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Use this modifier if the procedure was repeated by the same physician.
13. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Use this modifier if the procedure was 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 required 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 was performed by the same physician during the postoperative period of the initial procedure.
16. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was required for the procedure.
17. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon was required for the procedure.
18. 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.
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 assisted in the surgery.
Proper use of these modifiers can help ensure that claims are processed correctly and that healthcare providers receive appropriate reimbursement for their services. Always refer to the latest coding guidelines and payer-specific policies when applying modifiers.
CPT code 23675 is reimbursed by Medicare, but it is essential to verify the specific reimbursement 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 23675. Each MAC may have unique guidelines and policies, so direct communication with them ensures accurate and up-to-date information.
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