CPT code 24073 is for the surgical removal of a deep tumor in the arm or elbow area, measuring more than 5 cm.
CPT code 24075 is used to describe the surgical procedure for excising (removing) a lesion from the arm or elbow that is smaller than 3 centimeters. This code is specific to the size and location of the lesion, ensuring accurate billing and documentation for this particular type of surgery.
When billing for CPT code 24075 (Excision of soft tissue lesion, arm or elbow area; subcutaneous, less than 3 cm), it is important to consider the appropriate use of modifiers to ensure accurate reimbursement and to reflect the specific circumstances of the procedure. Below is a list of potential modifiers that could be used with CPT code 24075, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 50 - Bilateral Procedure
- Use this modifier if the procedure was performed on both arms or elbows during the same session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session. This indicates that the procedure is one of several performed.
4. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the procedure is distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
5. Modifier LT - Left Side
- Use this modifier to specify that the procedure was performed on the left arm or elbow.
6. Modifier RT - Right Side
- Use this modifier to specify that the procedure was performed on the right arm or elbow.
7. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same procedure is repeated by the same physician on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if the same procedure is repeated by a different physician on the same day.
9. 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 requires a return to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if the procedure is performed by the same physician during the postoperative period of another procedure, but is unrelated to the original procedure.
11. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon was required during the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted 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 24075 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates. However, it is essential to verify the specific coverage and reimbursement details with your regional Medicare Administrative Contractor (MAC), as they are responsible for processing Medicare claims and can provide the most accurate and up-to-date information regarding the reimbursement of CPT code 24075.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With RevFind, you can read your contracts and detect underpayments down to the CPT code level, including specific codes like 24075. Schedule a demo today to see how RevFind can help you identify and address underpayments by individual payer.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
