CPT code 24116 is for the excision or curettage of a bone cyst or tumor in the upper arm, specifically the humerus, with an allograft.
CPT code 24120 is used to describe the surgical procedure for the excision or curettage of a bone cyst or benign tumor in the radius. This code is specific to the removal of non-cancerous growths or cysts from the radius bone, which is one of the two large bones in the forearm. The procedure involves either cutting out the abnormal tissue or scraping it away to ensure that the bone remains healthy and functional.
When billing for CPT code 24120 (Excision or curettage of bone cyst or benign tumor of the radius), certain modifiers may be required to provide additional information about the procedure. Below is a list of potential modifiers that could be used with CPT code 24120, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort than typically required.
2. Modifier 50 - Bilateral Procedure
- Use this modifier if the procedure was performed on both the left and right radius.
3. Modifier 51 - Multiple Procedures
- Use this modifier if multiple procedures were performed during the same surgical session.
4. Modifier 52 - Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. 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.
6. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same procedure was repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if the same procedure was repeated by a different physician on the same day.
8. 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 had to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if the procedure was unrelated to the original procedure and performed during the postoperative period.
10. Modifier LT - Left Side
- Use this modifier to indicate that the procedure was performed on the left radius.
11. Modifier RT - Right Side
- Use this modifier to indicate that the procedure was performed on the right radius.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier if the procedure involved an assistant at surgery who is a physician assistant, nurse practitioner, or clinical nurse specialist.
By using the appropriate modifiers, healthcare providers can ensure accurate billing and reimbursement for the services rendered. Always refer to the latest coding guidelines and payer-specific requirements to confirm the correct use of modifiers.
CPT code 24120 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any potential coverage limitations, healthcare providers should consult the MPFS, which provides detailed information on payment rates for services covered by Medicare. Additionally, it is essential to verify with the relevant Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and can provide specific guidance on local coverage determinations and any additional documentation requirements that may apply to CPT code 24120.
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 24120, and by individual payer. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.
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