CPT code 24342 is for the surgical repair of a ruptured tendon in the upper arm, ensuring proper function and mobility restoration.
CPT code 24343 is used to describe the surgical procedure for repairing the lateral ligament of the elbow using tissue grafts. This code is typically utilized when a patient has experienced significant damage or instability in the lateral ligament of the elbow, often due to injury or overuse, and requires surgical intervention to restore proper function and stability. The procedure involves the use of tissue grafts to reconstruct and strengthen the damaged ligament.
When billing for CPT code 24343 (Repair of elbow lateral collateral ligament with tissue graft), it is essential to consider the appropriate use of modifiers to ensure accurate and complete claims submission. Below is a list of potential modifiers that could be used with CPT code 24343, 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 the patient's condition.
2. Modifier 50 - Bilateral Procedure
- Use this modifier if the procedure was performed on both elbows during the same surgical session.
3. Modifier 51 - Multiple Procedures
- Use this modifier if multiple procedures were performed during the same surgical session. This indicates that the procedure was one of several performed.
4. Modifier 52 - Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same procedure was repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if the same procedure was repeated by a different physician on the same day.
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
- Use this modifier if the patient required 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
- Use this modifier if the procedure was unrelated to the original procedure and was performed during the postoperative period.
10. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon was required during the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted in the surgery.
14. Modifier LT - Left Side (used to identify procedures performed on the left side of the body)
- Use this modifier if the procedure was performed on the left elbow.
15. Modifier RT - Right Side (used to identify procedures performed on the right side of the body)
- Use this modifier if the procedure was performed on the right elbow.
Proper use of these modifiers ensures that claims are processed correctly and that the healthcare provider receives appropriate reimbursement for the services rendered. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
The CPT code 24343 is reimbursed by Medicare, but it is essential to verify the specific reimbursement rate and coverage details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates. Additionally, it is advisable to consult with your regional Medicare Administrative Contractor (MAC) for any local coverage determinations or specific billing guidelines that may affect reimbursement for CPT code 24343.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 24343, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify and address underpayments by individual payer.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
