CPT code 24420 is a medical billing code used to describe the surgical revision of the humerus, ensuring accurate documentation and reimbursement.
CPT code 24430 is used for the surgical procedure involving the repair of the humerus, which is the bone of the upper arm. This code specifically refers to the surgical intervention required to fix fractures, dislocations, or other injuries to the humerus, ensuring proper alignment and healing.
When billing for CPT code 24430 (Repair of humerus), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of modifiers that could be used with CPT code 24430, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier when the work required to perform the procedure is substantially greater than typically required. Documentation must support the additional effort.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure is performed on both sides of the body during the same operative session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
4. Modifier 52 - Reduced Services
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion. Documentation should support the reduction in services.
5. Modifier 53 - Discontinued Procedure
- Apply this modifier if the procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
7. Modifier 62 - Two Surgeons
- This modifier is used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
8. Modifier 66 - Surgical Team
- Apply this modifier when a team of surgeons is required to perform the procedure due to its complexity.
9. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same physician repeats the procedure on the same day.
10. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used when a procedure is repeated by another physician on the same day.
11. 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 requires an unplanned return to the operating room for a related procedure during the postoperative period.
12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
13. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required to assist the primary surgeon during the procedure.
14. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier when a minimum assistant surgeon is required for the procedure.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier when an assistant surgeon is required because a qualified resident surgeon is not available.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
Proper use of these modifiers can help ensure that claims for CPT code 24430 are processed correctly and that healthcare providers receive appropriate reimbursement for their services. Always refer to the latest coding guidelines and payer-specific policies for the most accurate information.
The CPT code 24430 is reimbursed by Medicare, but it is essential to verify its inclusion in the Medicare Physician Fee Schedule (MPFS) to determine the specific reimbursement rate. The MPFS provides a comprehensive list of services covered by Medicare and their corresponding payment amounts. Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) are responsible for processing claims and setting local coverage determinations. Therefore, it is advisable to consult the relevant MAC for your area to confirm the specific reimbursement details for CPT code 24430.
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 24430. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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