CPT code 24079 is for the surgical removal of a tumor or tissue in the upper arm or elbow area, measuring 5 cm or larger.
CPT code 24079 is used to describe a surgical procedure involving the radical resection (removal) of a tumor or tissue in the upper arm or elbow area that is 5 centimeters or larger in size. This code is specifically utilized to document and bill for the extensive surgical effort required to excise larger tumors or tissue masses in this particular region of the body.
When billing for CPT code 24079 (Radical resection of tumor; soft tissue of upper arm or elbow area, 5 cm or greater), it is important 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 24079, 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. Documentation must support the additional effort.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both the left and right 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 modifier indicates that the procedure is one of several performed.
4. Modifier 52 - Reduced Services: Used when the procedure is partially reduced or eliminated at the physician's discretion. Documentation should support the reason for the reduction.
5. Modifier 53 - Discontinued Procedure: Used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This modifier is often used to bypass National Correct Coding Initiative (NCCI) edits.
7. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
8. Modifier 66 - Surgical Team: Used when a highly complex procedure is carried out by a surgical team.
9. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician subsequent to the original procedure.
10. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician subsequent to the original procedure.
11. 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 related procedure is performed during the postoperative period of the initial procedure.
12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
13. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
14. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required and a qualified resident surgeon is not available.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in surgery.
17. Modifier LT - Left Side: Used to specify that the procedure was performed on the left side of the body.
18. Modifier RT - Right Side: Used to specify that the procedure was performed on the right side of the body.
Each of these modifiers serves a specific purpose and should be used in accordance with payer guidelines and documentation requirements to ensure proper coding and reimbursement.
CPT code 24079 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 and the corresponding payment rates. However, it is important to note that the final determination of reimbursement for CPT code 24079 may also depend on the policies of the Medicare Administrative Contractor (MAC) for your region. MACs are responsible for processing Medicare claims and may have additional local coverage determinations (LCDs) that affect whether and how a particular CPT code is reimbursed. Therefore, it is advisable to consult both the MPFS and your regional MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 24079.
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