CPT code 23680 is for the surgical fixation of a shoulder dislocation with a neck fracture.
CPT code 23680 is used to describe the surgical procedure for the open treatment of a shoulder dislocation with a fracture of the neck of the humerus, including internal fixation when performed. This code is typically used by orthopedic surgeons to document and bill for the complex procedure of realigning the shoulder joint and securing the fractured bone using surgical hardware.
When billing for CPT code 23680 (Open treatment of shoulder dislocation with fracture of greater humeral tuberosity, with or without internal or external 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. This could be due to complications or additional time and effort needed during the procedure.
2. Modifier 51 (Multiple Procedures): Applied when multiple procedures are performed during the same surgical session. This helps in indicating that more than one procedure was carried out.
3. Modifier 52 (Reduced Services): Used when a service or procedure is partially reduced or eliminated at the physician's discretion. This modifier indicates that the procedure was not performed in its entirety.
4. Modifier 58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period): Used if a subsequent procedure is planned or anticipated, is more extensive than the original procedure, or is for therapy following a surgical procedure.
5. Modifier 59 (Distinct Procedural Service): Indicates that a procedure or service was distinct or independent from other services performed on the same day. This is used to identify procedures that are not typically reported together but are appropriate under the circumstances.
6. 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 subsequent to the original procedure.
7. Modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional): Applied when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure.
8. 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 patient requires a return to the operating room for a related procedure during the postoperative period of the initial surgery.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Indicates that an unrelated procedure or service was performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required during the procedure.
11. Modifier 81 (Minimum Assistant Surgeon): Applied when a minimum assistant surgeon is required during the procedure.
12. 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.
13. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery): Indicates that a non-physician practitioner assisted in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement for the services provided.
CPT code 23680 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides a comprehensive list of services and their corresponding reimbursement rates. To determine the exact reimbursement for CPT code 23680, healthcare providers should refer to the MPFS.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide region-specific information regarding coverage and reimbursement rates for CPT code 23680. It is advisable for healthcare providers to consult their respective MAC for detailed guidance on the reimbursement process for this specific code.
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