CPT code 24130 is a medical billing code used to describe the surgical procedure for the excision of the radial head.
CPT code 24134 is for a surgical procedure known as a sequestrectomy of the shaft or distal humerus. This involves the removal of a piece of dead bone (sequestrum) from the shaft or lower end of the upper arm bone (humerus). This procedure is typically performed to treat infections or other conditions that have caused the bone tissue to die.
When billing for CPT code 24134 (Sequestrectomy, shaft or distal humerus), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. Documentation must support the substantial additional work.
2. Modifier 50 - Bilateral Procedure: If the sequestrectomy is performed on both humeri, this modifier should be appended to indicate a bilateral procedure.
3. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier should be used to indicate that more than one procedure was performed.
4. Modifier 52 - Reduced Services: If the procedure was partially reduced or eliminated at the physician's discretion, this modifier should be used.
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: If the same physician needs to repeat the procedure on the same day, this modifier should be used.
7. Modifier 77 - Repeat Procedure by Another Physician: If a different physician repeats the procedure on the same day, this modifier should be appended.
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 needs 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: If an unrelated procedure is performed by the same physician during the postoperative period, this modifier should be used.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon was necessary for the procedure, this modifier should be appended.
11. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon was required.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): If an assistant surgeon was required due to the unavailability of a qualified resident surgeon, this modifier should be used.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: If a non-physician practitioner assisted in the surgery, this modifier should be appended.
14. Modifier LT - Left Side: If the procedure was performed on the left humerus, this modifier should be used.
15. Modifier RT - Right Side: If the procedure was performed on the right humerus, this modifier should be used.
Each modifier serves a specific purpose and should be used accurately to ensure proper billing and reimbursement. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
The CPT code 24134 is reimbursed by Medicare, but it is essential to verify its inclusion in the Medicare Physician Fee Schedule (MPFS) to determine the specific reimbursement rate. The MPFS provides a comprehensive list of services covered by Medicare and their corresponding payment amounts. Additionally, reimbursement for CPT code 24134 may vary depending on the region, as Medicare Administrative Contractors (MACs) have the authority to make local coverage determinations. Therefore, it is advisable to consult the relevant MAC for your area to confirm the reimbursement details for CPT code 24134.
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