CPT code 23920 is for the surgical procedure of shoulder disarticulation, which involves the removal of the arm at the shoulder joint.
CPT code 23920 is used to describe the surgical procedure of shoulder disarticulation. This involves the removal of the entire arm at the shoulder joint, including the humerus (upper arm bone) and the shoulder blade (scapula). This procedure is typically performed due to severe trauma, malignancies, or infections that cannot be managed through less extensive surgeries.
For CPT code 23920 (Disarticulation shoulder), 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 factors such as increased intensity, time, technical difficulty, or severity of the patient's condition.
2. Modifier 50 - Bilateral Procedure: If the disarticulation is performed on both shoulders during the same surgical session, this modifier should be used.
3. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier should be appended to indicate that more than one procedure was performed.
4. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day. This could be due to different sessions, different procedures, or different sites.
5. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure needs to be repeated by the same physician, this modifier should be used.
6. Modifier 77 - Repeat Procedure by Another Physician: If the procedure is repeated by a different physician, this modifier should be appended.
7. 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.
8. 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.
9. Modifier LT - Left Side: If the disarticulation is performed on the left shoulder, this modifier should be appended.
10. Modifier RT - Right Side: If the disarticulation is performed on the right shoulder, this modifier should be appended.
11. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Use this modifier if the procedure involves an assistant at surgery who is a physician assistant, nurse practitioner, or clinical nurse specialist.
These modifiers help provide additional information about the circumstances of the procedure, ensuring accurate billing and reimbursement.
The CPT code 23920 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. To determine if CPT code 23920 is covered and the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered by Medicare. Additionally, it is essential to consult with your local Medicare Administrative Contractor (MAC), as they are responsible for processing Medicare claims and can provide region-specific guidance on coverage and reimbursement for CPT code 23920.
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