CPT code 24147 is a medical code used to describe the partial excision of the bone in the olecranon process, commonly part of elbow surgery.
CPT code 24149 is for the radical resection of the elbow. This procedure involves the surgical removal of a significant portion of the elbow joint, often including surrounding tissues, to treat conditions such as tumors or severe joint damage. The goal is to eliminate diseased or damaged tissue while preserving as much function as possible.
When billing for CPT code 24149 (Radical resection of elbow), it is essential 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 24149, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more work than typically required. This could be due to factors such as increased intensity, time, technical difficulty, or severity of the patient's condition.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the radical resection of the elbow was performed on both elbows during the same operative session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures, other than E/M services, are performed at the same session by the same provider. This indicates that the radical resection of the elbow was one of several procedures performed.
4. Modifier 52 - Reduced Services
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion. For example, if the radical resection was not completed as initially planned.
5. Modifier 59 - Distinct Procedural Service
- Apply this modifier to indicate that the radical resection of the elbow was a distinct procedural service from other services performed on the same day. This is used to prevent bundling of services that are usually not reported together.
6. Modifier 62 - Two Surgeons
- Use this modifier if two surgeons worked together as primary surgeons performing distinct parts of the radical resection of the elbow.
7. Modifier 66 - Surgical Team
- This modifier is applicable if the procedure required the services of a surgical team due to its complexity.
8. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the radical resection of the elbow was repeated by the same physician on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if the radical resection of the elbow was repeated by a different physician on the same day.
10. 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 required an unplanned return to the operating room for a related procedure during the postoperative period of the initial radical resection of the elbow.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if an unrelated procedure was performed by the same physician during the postoperative period of the initial radical resection of the elbow.
12. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was necessary for the radical resection of the elbow.
13. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon was required for the procedure.
14. 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.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
By appropriately applying these modifiers, healthcare providers can ensure that their claims for CPT code 24149 are accurately represented and reimbursed.
CPT code 24149 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services covered by Medicare and can be accessed online for the most current information. Additionally, it is advisable to consult with your regional Medicare Administrative Contractor (MAC) to confirm any local coverage determinations or specific billing requirements that may affect reimbursement for CPT code 24149.
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 24149. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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