CPT code 24115 is a medical billing code for the excision or curettage of a bone cyst or tumor in the upper arm, specifically the humerus.
CPT code 24115 is used to describe the surgical procedure for the excision or curettage of a bone cyst or tumor in the upper arm (humerus) with the use of a graft. This means that a surgeon removes or scrapes out a cyst or tumor from the humerus and then uses a graft to help repair or reconstruct the bone. This procedure is typically performed to treat benign bone lesions and ensure the structural integrity of the bone.
When billing for CPT code 24115 (Excision or curettage of bone cyst or benign tumor of the humerus), 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
- Apply this modifier if the procedure was performed on both sides of the body during the same session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
4. Modifier 59 - Distinct Procedural Service
- This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. It 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 side of the body.
6. Modifier RT - Right Side
- Use this modifier to specify that the procedure was performed on the right side of the body.
7. Modifier 62 - Two Surgeons
- Apply this modifier if two surgeons worked together as primary surgeons performing distinct parts of the procedure.
8. Modifier 66 - Surgical Team
- Use this modifier when a complex procedure requires the services of a surgical team.
9. Modifier 76 - Repeat Procedure by Same Physician
- This modifier is used if the same physician repeats the procedure on the same day.
10. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if a different physician repeats the procedure on the same day.
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
- Apply this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period.
12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
13. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required for the procedure.
14. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier when a minimum assistant surgeon is required for the procedure.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier 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
- Use this modifier when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
Each modifier serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement. Proper documentation is essential to support the use of any modifier.
The CPT code 24115 is reimbursed by Medicare, but the reimbursement specifics depend on several factors, including the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your region. The MPFS provides a comprehensive list of fees that Medicare will pay for each CPT code, and it is updated annually to reflect changes in medical practice and economic conditions. Additionally, the MACs, which are regional contractors, have the authority to make determinations about coverage and reimbursement based on local policies and medical necessity. Therefore, while CPT code 24115 is generally reimbursable, it is essential to consult the MPFS and your specific MAC for the most accurate and up-to-date information regarding reimbursement rates and coverage criteria.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 24115, and by individual payer. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements and maximize your revenue.
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