CPT code 24305 is a medical code used to describe the procedure of tendon lengthening in the upper arm or elbow for each tendon.
CPT code 24310 is used to describe a surgical procedure known as "tenotomy" of the elbow, specifically for each tendon. This procedure involves the surgical release or cutting of a tendon in the elbow to relieve pain or improve function. It is typically performed to address conditions such as tendonitis or other tendon-related issues in the elbow.
For CPT code 24310 (Tenotomy, open, elbow to shoulder, each tendon), the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Use this modifier if the procedure required significantly greater effort than typically required. Documentation must support the substantial additional work.
2. Modifier 50 (Bilateral Procedure): If the tenotomy procedure is performed on both sides of the body, this modifier should be appended to indicate a bilateral procedure.
3. Modifier 51 (Multiple Procedures): When multiple procedures are performed during the same surgical session, this modifier should be used to indicate that multiple services were provided.
4. Modifier 52 (Reduced Services): If the procedure was partially reduced or eliminated at the physician's discretion, this modifier should be used to indicate that the service provided was less than usually required.
5. Modifier 59 (Distinct Procedural Service): This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day. It is typically used to identify procedures that are not normally reported together but are appropriate under the circumstances.
6. Modifier 76 (Repeat Procedure by Same Physician): If the same procedure is repeated by the same physician, this modifier should be used to indicate the repetition of the service.
7. Modifier 77 (Repeat Procedure by Another Physician): If the procedure is repeated by a different physician, this modifier should be used to indicate the repetition of the service by another provider.
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): This modifier is used if the patient requires an unplanned 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 to indicate that the service is not related to the initial procedure.
10. Modifier LT (Left Side): Use this modifier to indicate that the procedure was performed on the left side of the body.
11. Modifier RT (Right Side): Use this modifier to indicate that the procedure was performed on the right side of the body.
12. Modifier XS (Separate Structure): This modifier is used to indicate that a service was performed on a separate organ/structure.
13. Modifier XE (Separate Encounter): This modifier is used to indicate that a service was performed during a separate encounter.
14. Modifier XP (Separate Practitioner): This modifier is used to indicate that a service was performed by a different practitioner.
15. Modifier XU (Unusual Non-Overlapping Service): This modifier is used to indicate that a service does not overlap usual components of the main service.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always ensure proper documentation is in place to support the use of any modifiers.
The CPT code 24310 is reimbursed by Medicare, but it is essential to verify its specific reimbursement status through the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered under Medicare Part B. Additionally, reimbursement can vary based on the policies of the Medicare Administrative Contractor (MAC) for your region. Each MAC may have specific guidelines and coverage determinations that can influence whether and how a particular CPT code is reimbursed. Therefore, it is advisable to consult both the MPFS and your regional MAC to ensure accurate and up-to-date information regarding the reimbursement of CPT code 24310.
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 24310, and by individual payer. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.
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