CPT Code 23200

CPT code 23200 is a medical billing code used to describe the surgical procedure for resecting a tumor from the clavicle.

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What is CPT Code 23200

CPT code 23200 is used to describe the surgical procedure for the resection of a clavicle tumor. This involves the removal of a tumor located on the clavicle (collarbone) to prevent the spread of cancer or alleviate symptoms caused by the tumor. The procedure is typically performed by an orthopedic surgeon or a surgical oncologist and may involve the use of various surgical techniques to ensure complete removal of the tumor while preserving as much of the surrounding healthy tissue as possible.

Does CPT 23200 Need a Modifier?

When billing for CPT code 23200 (Resect clavicle tumor), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of potential modifiers that could be used with CPT code 23200, along with the reasons for their use:

1. Modifier 22 (Increased Procedural Services): Used when the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as increased complexity or time.

2. Modifier 50 (Bilateral Procedure): Applied if the procedure is performed on both sides of the body during the same operative session.

3. Modifier 51 (Multiple Procedures): Used when multiple procedures are performed during the same surgical session. This helps indicate that more than one procedure was carried out.

4. Modifier 52 (Reduced Services): Used when the procedure is partially reduced or eliminated at the physician's discretion. This modifier indicates that the service provided was less than usually required.

5. Modifier 59 (Distinct Procedural Service): Applied to indicate that a procedure or service 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 62 (Two Surgeons): Used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.

7. Modifier 66 (Surgical Team): Applied when a surgical team is required to perform the procedure due to its complexity.

8. Modifier 76 (Repeat Procedure by Same Physician): Used when the same physician performs a procedure or service more than once on the same day.

9. Modifier 77 (Repeat Procedure by Another Physician): Applied when a procedure or service is repeated by another physician on the same day.

10. 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.

11. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Applied when a procedure or service performed during the postoperative period is unrelated to the original procedure.

12. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required to help perform the procedure.

13. Modifier 81 (Minimum Assistant Surgeon): Applied when a minimum assistant surgeon is required for the procedure.

14. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Used when an assistant surgeon is necessary, and a qualified resident surgeon is not available.

15. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Applied when a non-physician provider assists in the surgery.

Proper use of these modifiers can help ensure that claims are processed correctly and that the healthcare provider receives appropriate reimbursement for the services rendered. Always refer to the latest coding guidelines and payer-specific policies when applying modifiers.

CPT Code 23200 Medicare Reimbursement

The CPT code 23200 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, including their reimbursement rates. Additionally, MACs are responsible for processing Medicare claims and can offer detailed guidance on the reimbursement policies for CPT code 23200 in your specific region. Always consult these resources to ensure accurate and up-to-date information regarding Medicare reimbursement for this CPT code.

Are You Being Underpaid for 23200 CPT Code?

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