CPT code 24151 is for extensive humerus surgery, detailing the specific medical procedure for accurate billing and insurance purposes.
CPT code 24151 is used to describe an extensive surgical procedure on the humerus, which is the bone of the upper arm. This code specifically refers to a more complex surgery that involves significant repair or reconstruction of the humerus, often necessary due to severe fractures, bone tumors, or other serious conditions affecting the bone. This procedure typically requires specialized surgical skills and may involve the use of implants or grafts to restore the bone's function and structure.
For CPT code 24151, which pertains to extensive humerus surgery, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Used when the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as increased complexity or time.
2. Modifier 50 - Bilateral Procedure: Applied if the extensive humerus surgery is performed on both arms during the same operative session.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session. This modifier indicates that the extensive humerus surgery is one of several procedures.
4. Modifier 52 - Reduced Services: Applied if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Used if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service: Indicates that the extensive humerus surgery was distinct or independent from other services performed on the same day.
7. Modifier 62 - Two Surgeons: Applied when two surgeons work together as primary surgeons performing distinct parts of the procedure.
8. Modifier 66 - Surgical Team: Used when the procedure requires the skills of a surgical team.
9. Modifier 76 - Repeat Procedure by Same Physician: Applied if the same physician needs to repeat the extensive humerus surgery within a short period.
10. Modifier 77 - Repeat Procedure by Another Physician: Used if a different physician repeats the extensive humerus surgery within a short period.
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: Applied 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: Used if the extensive humerus surgery is performed during the postoperative period of another procedure but is unrelated to the initial surgery.
13. Modifier 80 - Assistant Surgeon: Applied when an assistant surgeon is required for the procedure.
14. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required for the procedure.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Applied when an assistant surgeon is necessary because a qualified resident surgeon is not available.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Used when these non-physician practitioners assist in the surgery.
Each of these modifiers provides additional information that can affect billing and reimbursement for the extensive humerus surgery, ensuring that the specifics of the procedure are accurately communicated to payers.
The CPT code 24151 is reimbursed by Medicare, but it is essential to verify the specifics 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 local coverage decisions and can offer more detailed guidance on whether CPT code 24151 is reimbursed in your specific region. Always consult the MPFS and your MAC to ensure accurate and up-to-date information regarding reimbursement for CPT code 24151.
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