CPT code 24152 is a medical code used to describe the procedure for the radical resection of a tumor in the head or neck of the radius bone.
CPT code 24153 is used to describe an extensive surgical procedure on the radius, which is one of the two large bones in the forearm. This code is typically used when a surgeon performs a complex operation that may involve repairing, reconstructing, or removing parts of the radius due to injury, disease, or other medical conditions. The use of this code helps ensure accurate billing and documentation for the healthcare services provided.
When billing for CPT code 24153 (Extensive radius surgery), 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 24153, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier when the work required to perform the procedure is substantially greater than typically required. Documentation must support the additional effort.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the extensive radius surgery is performed on both the left and right radius 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 helps indicate that multiple procedures were performed.
4. Modifier 52 - Reduced Services
- This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. Documentation should support the reduction in services.
5. Modifier 59 - Distinct Procedural Service
- Apply this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is often used to bypass NCCI edits.
6. Modifier 62 - Two Surgeons
- Use this modifier when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
7. Modifier 66 - Surgical Team
- This modifier is used when a team of surgeons (more than two) is required to perform the procedure due to the complexity of the surgery.
8. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the same physician needs to repeat the procedure on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier when a procedure is repeated by another 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
- This modifier is used when the patient returns to the operating room for a related procedure during the postoperative period of the initial surgery.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier when an unrelated procedure is performed by the same physician during the postoperative period of the initial surgery.
12. Modifier 80 - Assistant Surgeon
- Use this modifier when an assistant surgeon is required to assist with the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- This modifier is used when an assistant surgeon provides minimal assistance during the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier when an assistant surgeon is required, and a qualified resident surgeon is not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier when a non-physician provider assists in the surgery.
By appropriately applying these modifiers, healthcare providers can ensure that their claims for CPT code 24153 are accurately processed and reimbursed. Proper documentation is crucial to support the use of any modifiers.
Determining whether CPT code 24153 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS provides a comprehensive list of services and their corresponding reimbursement rates under Medicare Part B.
To ascertain if CPT code 24153 is reimbursed, you would need to check the MPFS database, which is accessible through the Centers for Medicare & Medicaid Services (CMS) website. Additionally, MACs, which are private health care insurers contracted by CMS to process Medicare claims, may have specific local coverage determinations (LCDs) that affect reimbursement.
Therefore, to confirm if CPT code 24153 is reimbursed by Medicare, you should review the MPFS and consult the relevant MAC for any specific guidelines or restrictions that may apply.
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 24153. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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