CPT code 23800 is a medical code used to describe the surgical procedure of arthrodesis of the glenohumeral joint, which is the shoulder joint.
CPT code 23800 is used to describe the surgical procedure known as arthrodesis of the glenohumeral joint. This procedure involves the fusion of the shoulder joint (glenohumeral joint) to alleviate pain or restore stability, often due to severe arthritis, fractures, or other debilitating conditions. By fusing the bones together, the joint is immobilized, which can significantly reduce pain and improve the patient's quality of life.
For CPT code 23800 (Arthrodesis glenohumeral joint), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or other factors that increase the complexity of the surgery.
2. Modifier 50 - Bilateral Procedure: If the arthrodesis is performed on both shoulders during the same surgical session, this modifier should be appended.
3. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier should be used to indicate that 23800 is one of several procedures.
4. Modifier 52 - Reduced Services: If the procedure was partially reduced or eliminated at the physician's discretion, this modifier should be used.
5. 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.
6. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day.
7. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure, this modifier should be used to indicate the collaborative effort.
8. Modifier 66 - Surgical Team: If the procedure requires a surgical team, this modifier should be appended.
9. Modifier 76 - Repeat Procedure by Same Physician: If the same physician needs to repeat the procedure, this modifier should be used.
10. Modifier 77 - Repeat Procedure by Another Physician: If another physician needs to repeat the procedure, this modifier should be used.
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 needs 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: If an unrelated procedure is performed by the same physician during the postoperative period, this modifier should be used.
13. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required, this modifier should be appended.
14. Modifier 81 - Minimum Assistant Surgeon: If a minimum assistant surgeon is required, this modifier should be used.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier if an assistant surgeon is required because a qualified resident surgeon is not available.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: This modifier is used when these non-physician practitioners assist in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 23800 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 local Medicare Administrative Contractor (MAC) to confirm any regional variations or specific guidelines that may affect the reimbursement of CPT code 23800. The MACs are responsible for processing Medicare claims and can provide detailed information on coverage and payment policies.
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