CPT code 24435 is for the surgical repair of the humerus using a graft, typically performed to treat fractures or bone defects.
CPT code 24435 is used to describe the surgical procedure for repairing the humerus (the upper arm bone) using a graft. This code is specifically for cases where the humerus has been damaged or fractured and requires the addition of a graft material to facilitate proper healing and restore function. The graft can be made from the patient's own tissue or from a donor, and it helps to support and stabilize the bone during the recovery process.
When billing for CPT code 24435 (Repair humerus with graft), 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 24435, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort or complexity than typically required. Documentation must support the increased effort.
2. Modifier 51 - Multiple Procedures
- Apply this modifier if multiple procedures were performed during the same surgical session. This indicates that more than one procedure was carried out, which may affect reimbursement.
3. Modifier 52 - Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion. This indicates that the full service described by the CPT code was not performed.
4. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if the procedure was planned or anticipated (staged) or more extensive than the original procedure, or for therapy following a surgical procedure.
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. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 62 - Two Surgeons
- Apply this modifier if two surgeons worked together as primary surgeons performing distinct parts of the procedure. Each surgeon should report their distinct operative work.
7. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Use this modifier if the same procedure was repeated by the same physician or other qualified healthcare professional subsequent to the original procedure.
8. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Apply this modifier if the same procedure was repeated by a different physician or other qualified healthcare professional subsequent to the original procedure.
9. 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 of the initial surgery.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if an unrelated procedure or service was performed by the same physician during the postoperative period of the initial procedure.
11. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was necessary to assist with the procedure.
12. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon was required for the procedure.
13. 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.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Apply this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted in the surgery.
Proper use of these modifiers ensures that the billing accurately reflects the services provided and helps in obtaining appropriate reimbursement. Always refer to the latest coding guidelines and payer-specific policies to confirm the correct application of modifiers.
CPT code 24435 is reimbursed by Medicare, but the reimbursement amount can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered by Medicare, including CPT code 24435. To determine the exact reimbursement rate for this code, healthcare providers should refer to the MPFS, which is updated annually.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing Medicare claims and can provide specific guidance on reimbursement for CPT code 24435. MACs may have local coverage determinations (LCDs) that affect whether and how this code is reimbursed in different regions. Therefore, it is advisable for healthcare providers to consult their respective MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 24435.
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