CPT code 24350 is for the surgical repair of tennis elbow, a procedure to alleviate pain and restore function in the elbow.
CPT code 24350 is used for the surgical procedure to repair tennis elbow, also known as lateral epicondylitis. This code specifically refers to the surgical intervention where the damaged tendons in the elbow are repaired to alleviate pain and restore function. This procedure is typically considered when conservative treatments, such as physical therapy and medications, have not provided sufficient relief.
When billing for CPT code 24350 (Repair of tennis elbow), 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 24350, 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. Documentation must support the increased complexity.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the repair of tennis elbow was performed on both elbows during the same surgical 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.
4. Modifier 52 - Reduced Services
- This modifier is used if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service
- Apply 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
- This modifier is used 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
- Apply 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 an unrelated procedure was performed by the same physician during the postoperative period of the initial procedure.
10. Modifier LT - Left Side
- Apply this modifier if the procedure was performed on the left elbow.
11. Modifier RT - Right Side
- Use this modifier if the procedure was performed on the right elbow.
12. Modifier 99 - Multiple Modifiers
- This modifier is used when two or more modifiers are necessary to describe the service provided accurately.
Proper use of these modifiers ensures that claims are processed correctly and that healthcare providers receive appropriate reimbursement for their services. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
The CPT code 24350 is reimbursed by Medicare, but it is essential to verify its specific reimbursement rate and coverage details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of fees that Medicare uses to reimburse physicians and other healthcare providers for their services. Additionally, it is crucial to consult with your local Medicare Administrative Contractor (MAC) to confirm any regional variations or specific guidelines that may affect the reimbursement of CPT code 24350. Each MAC may have unique policies or requirements that could influence the reimbursement process.
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 24350. Ensure you're receiving the full reimbursement you deserve from every payer. Schedule a demo today to see RevFind in action and safeguard your revenue.
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