CPT Code 23174

CPT code 23174 is a medical billing code used to describe the procedure for removing a lesion from the humerus.

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What is CPT Code 23174

CPT code 23174 is used to describe the surgical procedure for the removal of a lesion from the humerus, which is the upper arm bone. This code is specifically utilized when a surgeon excises or removes an abnormal growth or mass from the humerus, ensuring that the procedure is accurately documented for billing and insurance purposes.

Does CPT 23174 Need a Modifier?

When billing for CPT code 23174 (Remove humerus lesion), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of modifiers that could be used with CPT code 23174, 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. This could be due to factors such as the size or location of the lesion, or the presence of extensive scar tissue.

2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both humeri during the same surgical session.

3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session. This helps indicate that more than one procedure was carried out.

4. Modifier 59 - Distinct Procedural Service
- This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day. It is particularly useful when the removal of the humerus lesion is performed in conjunction with other procedures that are not typically reported together.

5. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same procedure is repeated by the same physician on the same day.

6. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if the procedure is repeated by a different physician on the same day.

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
- This modifier is used if the patient needs to return to the operating room for a related procedure during the postoperative period of the initial surgery.

8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial surgery.

9. Modifier LT - Left Side
- Apply this modifier to indicate that the procedure was performed on the left humerus.

10. Modifier RT - Right Side
- Use this modifier to indicate that the procedure was performed on the right humerus.

11. Modifier 99 - Multiple Modifiers
- This modifier is used when two or more modifiers are necessary to describe the service accurately.

By appropriately applying these modifiers, healthcare providers can ensure accurate billing and improve the likelihood of proper reimbursement for the services rendered.

CPT Code 23174 Medicare Reimbursement

The CPT code 23174 is reimbursed by Medicare, but it is essential to verify its inclusion in the Medicare Physician Fee Schedule (MPFS) for the specific year in question. The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates. Additionally, reimbursement can vary based on the policies of the Medicare Administrative Contractor (MAC) for your region. Each MAC may have specific guidelines and requirements that could affect the reimbursement process for CPT code 23174. Therefore, it is advisable to consult the MPFS and your regional MAC to ensure accurate and up-to-date information regarding the reimbursement of this CPT code.

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