CPT code 24071 is for the excision of a lesion from the arm or elbow, measuring 3 cm or less.
CPT code 24073 is used to describe the surgical procedure for the excision (removal) of a deep tumor located in the arm or elbow area that is larger than 5 centimeters. This code is specifically for cases where the tumor is situated deep within the tissues, requiring a more complex and invasive surgical approach compared to superficial tumors.
When billing for CPT code 24073 (Excision of tumor, soft tissue of upper arm or elbow area, deep, subfascial, intramuscular; 5 cm or greater), 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.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both arms or elbows during the same session, this modifier should be appended.
3. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier should be used to indicate that multiple services were provided.
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.
5. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure is repeated by the same physician on the same day, this modifier should be used.
6. Modifier 77 - Repeat Procedure by Another Physician: If the procedure is repeated by a different physician on the same day, 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: This modifier is used if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier LT - Left Side: Use this modifier to specify that the procedure was performed on the left arm or elbow.
10. Modifier RT - Right Side: Use this modifier to specify that the procedure was performed on the right arm or elbow.
11. Modifier 99 - Multiple Modifiers: If more than four modifiers are necessary to describe the service, this modifier should be used to indicate that multiple modifiers are being applied.
Each of these modifiers serves a specific purpose and should be used according to the clinical scenario and payer requirements to ensure accurate billing and reimbursement.
CPT code 24073 is reimbursed by Medicare, but it is essential to verify the specific details 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 the reimbursement rates for each CPT code. Additionally, MACs administer Medicare claims and can offer region-specific guidance on coverage and reimbursement policies. Therefore, to ensure accurate and up-to-date information, healthcare providers should consult both the MPFS and their respective MAC.
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