CPT code 24150 is for the surgical removal of a tumor from the distal or shaft area of the humerus (upper arm bone).
CPT code 24150 is used to describe a surgical procedure involving the radical resection of a tumor located in the distal or shaft portion of the humerus. This code is specifically for cases where a significant portion of the bone is removed to ensure the complete excision of the tumor.
When billing for CPT code 24150 (Radical resection of tumor, distal humerus or proximal to shaft, with or without allograft), 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 24150, 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 complications or unusual circumstances that increased the complexity of the surgery.
2. Modifier 50 (Bilateral Procedure):
- If the procedure is performed on both arms during the same surgical session, this modifier should be appended to indicate a bilateral procedure.
3. Modifier 51 (Multiple Procedures):
- Apply this modifier when multiple procedures are performed during the same surgical session. This helps to indicate that more than one procedure was carried out.
4. Modifier 52 (Reduced Services):
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion. This could occur if the full extent of the planned procedure was not necessary.
5. Modifier 59 (Distinct Procedural Service):
- This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is particularly useful when the procedures are not typically reported together but are appropriate under the circumstances.
6. Modifier 62 (Two Surgeons):
- If two surgeons are required to perform the procedure due to its complexity, this modifier should be used to indicate that both surgeons were necessary and actively involved.
7. Modifier 66 (Surgical Team):
- Apply this modifier when the procedure requires a surgical team due to its complexity, indicating that multiple providers were involved in the surgery.
8. Modifier 76 (Repeat Procedure by Same Physician):
- Use this modifier if the same physician needs to repeat the procedure on the same day due to unforeseen circumstances.
9. Modifier 77 (Repeat Procedure by Another Physician):
- This modifier is used when a different physician repeats the procedure 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 needs to return to the operating room for a related procedure during the postoperative period.
11. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period):
- Apply this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
12. Modifier 80 (Assistant Surgeon):
- This modifier is used when an assistant surgeon is required to help with the procedure.
13. Modifier 81 (Minimum Assistant Surgeon):
- Use this modifier if a minimum assistant surgeon is required for the procedure.
14. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)):
- Apply this modifier when an assistant surgeon is necessary because a qualified resident surgeon is 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.
Properly applying these modifiers ensures that the billing accurately reflects the services provided, which can help in achieving appropriate reimbursement and avoiding claim denials. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
The CPT code 24150 is reimbursed by Medicare, but it is essential to verify the specific details through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, including the associated reimbursement rates. Additionally, MACs play a crucial role in determining the local coverage and payment policies for specific CPT codes. Therefore, while CPT code 24150 is generally reimbursed by Medicare, healthcare providers should consult the MPFS and their respective MAC for precise information on coverage and reimbursement rates.
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