CPT code 24354 is for the surgical repair of tennis elbow, a procedure to alleviate pain and restore function in the elbow.
CPT code 24356 is used to describe the surgical procedure for the revision of tennis elbow. This involves correcting or improving a previous surgery that was performed to treat tennis elbow, a condition characterized by pain and inflammation around the elbow due to overuse or repetitive motion. The revision surgery aims to alleviate symptoms and restore function to the affected area.
For CPT code 24356, which pertains to the revision of tennis elbow, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort or complexity than typically required.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the revision of tennis elbow was performed on both elbows during the same surgical session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session, including the revision of tennis elbow.
4. Modifier 52 - Reduced Services
- Apply 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 revision of tennis elbow was a distinct procedural service from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the same physician performed the revision of tennis elbow more than once on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if a different physician performed the revision of tennis elbow more than once 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 the revision of tennis elbow was performed during the postoperative period of another unrelated procedure.
10. Modifier 80 - Assistant Surgeon
- Apply this modifier if an assistant surgeon was necessary for the revision of tennis elbow.
11. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon was required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier if an assistant surgeon was necessary due to the unavailability of a qualified resident surgeon.
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.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement for the revision of tennis elbow procedure.
The CPT code 24356 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their respective payment rates. Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) may have localized policies and fee schedules. Therefore, it is advisable to consult the relevant MAC for your area to confirm the exact reimbursement rate and any specific guidelines associated with CPT code 24356.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and identify underpayments down to the CPT code level, including specific codes like 24356. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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