CPT code 23935 is a procedure for incision and drainage of an open bursa in the elbow or humerus, often due to infection or inflammation.
CPT code 23935 is used to describe an "incision and drainage of an open bursa in the shoulder or elbow." This procedure involves making an incision to drain fluid from a bursa, which is a small fluid-filled sac that reduces friction between tissues in the body. The code specifically applies to the shoulder (humerus) or elbow regions.
For CPT code 23935 (Incision and drainage, open, bursa, one or more, humerus/elbow), 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 and the reason for it.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both sides of the body during the same operative session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session. This helps indicate that the procedure was one of several performed.
4. Modifier 52 - Reduced Services
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion. Documentation should support the reason for the reduction.
5. Modifier 59 - Distinct Procedural Service
- Apply this modifier to indicate that the procedure was distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same procedure is repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if the same procedure is repeated by a different physician on the same day.
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
- This modifier is used when a patient returns to the operating room for a related procedure during the postoperative period of the initial procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier LT - Left Side
- Apply this modifier to indicate that the procedure was performed on the left side of the body.
11. Modifier RT - Right Side
- Use this modifier to indicate that the procedure was performed on the right side of the body.
12. Modifier XS - Separate Structure
- This modifier is used to indicate that a service was performed on a separate organ/structure.
13. Modifier XE - Separate Encounter
- Apply this modifier to indicate that a service was performed during a separate encounter.
14. Modifier XP - Separate Practitioner
- Use this modifier to indicate that a service was performed by a different practitioner.
15. Modifier XU - Unusual Non-Overlapping Service
- This modifier is used to indicate that the service does not overlap usual components of the main service.
Each modifier serves a specific purpose and should be used in accordance with the documentation and circumstances surrounding the procedure. Proper use of modifiers ensures accurate billing and reimbursement.
CPT code 23935 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 payment rates. Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) may have localized policies and fee schedules. Therefore, it is advisable to consult the relevant MAC for your area to obtain precise information regarding the reimbursement for CPT code 23935.
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