CPT code 24310 is a medical code used to describe a surgical procedure involving the elbow to shoulder area, specifically for tendon repair.
CPT code 24320 is a medical billing code used to describe a surgical procedure known as a tenoplasty of the elbow. This procedure involves the repair or reconstruction of a tendon in the elbow to restore its function and alleviate pain. It is typically performed to address conditions such as tendon injuries, tears, or degenerative changes that affect the elbow's movement and strength.
For CPT code 24320 (Tenoplasty, elbow, with or without tendon transposition), 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.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both elbows during the same session.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: Used when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by another physician.
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: Used when a related procedure is performed during the postoperative period of the initial procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier LT - Left Side: Used to specify that the procedure was performed on the left elbow.
11. Modifier RT - Right Side: Used to specify that the procedure was performed on the right elbow.
12. Modifier XS - Separate Structure: Used to indicate that a service was performed on a separate organ/structure.
13. Modifier XE - Separate Encounter: Used to indicate that a service was performed during a separate encounter.
14. Modifier XP - Separate Practitioner: Used to indicate that a service was performed by a different practitioner.
15. Modifier XU - Unusual Non-Overlapping Service: Used to indicate that the use of 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.
CPT code 24320 is reimbursed by Medicare, but the reimbursement specifics can vary. To determine the exact reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B. Additionally, it is essential to consult the local Medicare Administrative Contractor (MAC) for any region-specific guidelines or adjustments that may apply to the reimbursement of CPT code 24320. The MACs are responsible for processing Medicare claims and can provide detailed information on coverage and payment policies.
Discover how MD Clarity's RevFind software can meticulously read your contracts and detect underpayments down to the CPT code level, including specific codes like 24320, 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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