How To Use CPT Code 23076
CPT code 23076 describes the excision of a soft tissue tumor in the shoulder area that is subfascial, or within the intramuscular tissue, and is less than 5 cm in size. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.
1. What is CPT Code 23076?
CPT 23076 is used to describe the excision of a soft tissue tumor in the shoulder area that is subfascial, or within the intramuscular tissue. The tumor being removed must be less than 5 cm in size. This code is specifically for tumors located in the shoulder area and requires the provider to submit the excised specimen, including margins, for analysis and diagnosis.
2. Official Description
The official description of CPT code 23076 is: ‘Excision, tumor, soft tissue of shoulder area, subfascial (eg, intramuscular) less than 5 cm.’
3. Procedure
During the procedure for CPT 23076, the provider begins by appropriately prepping and anesthetizing the patient. An incision is made over the mass in the shoulder area. The incision is extended through the subcutaneous tissue and into the muscle tissue. Microdissection techniques are used to carefully excise the tumor and a margin of surrounding tissue. The excised specimen, including margins, is then submitted to a laboratory for analysis and diagnosis. The provider irrigates the wound area and closes the incision with sutures.
4. Qualifying circumstances
CPT 23076 is used for the excision of soft tissue tumors in the shoulder area that are subfascial, or within the intramuscular tissue. The tumor being removed must be less than 5 cm in size. This code is specific to tumors located in the shoulder area and does not apply to tumors in other areas of the body. It is important to accurately document the size and location of the tumor to support the use of this code.
5. When to use CPT code 23076
CPT code 23076 should be used when a provider is performing an excision of a soft tissue tumor in the shoulder area that is subfascial, or within the intramuscular tissue, and is less than 5 cm in size. It is important to ensure that the documentation supports the specific criteria outlined in the code description to accurately report this procedure.
6. Documentation requirements
To support a claim for CPT code 23076, the provider must document the following information:
- Size and location of the tumor
- Details of the excision procedure, including the incision, dissection, and closure
- Submission of the excised specimen, including margins, for analysis and diagnosis
7. Billing guidelines
When billing for CPT code 23076, it is important to ensure that the excised tumor meets the specific criteria outlined in the code description. This includes being subfascial, or within the intramuscular tissue, and less than 5 cm in size. It is also important to accurately document the procedure and submit the excised specimen for analysis and diagnosis. There are no specific guidelines regarding reporting this code with other codes, but it is important to review the documentation and determine if additional codes are necessary to accurately represent the services provided.
8. Historical information
CPT code 23076 was added to the Current Procedural Terminology system on January 1, 1990. On January 1, 2010, the code description was changed to specify that the excision is subfascial, or within the intramuscular tissue, and to include the size limitation of less than 5 cm.
9. Examples
- A provider excises a 3 cm soft tissue tumor located within the intramuscular tissue of the shoulder area.
- A patient presents with a 4 cm subfascial tumor in the shoulder area, and the provider performs an excision procedure to remove it.
- A provider performs an excision of a 2 cm soft tissue tumor located within the intramuscular tissue of the shoulder area, submitting the excised specimen for analysis and diagnosis.
- A patient undergoes an excision procedure for a 1 cm subfascial tumor in the shoulder area, with the provider ensuring that the excised specimen, including margins, is sent to a laboratory for analysis.
- A provider performs an excision of a 5 cm soft tissue tumor located within the intramuscular tissue of the shoulder area, using CPT code 23220 instead of 23076 due to the size limitation.
