CPT code 24500 is a medical code used to describe the treatment of a humerus fracture.
CPT code 24505 is used to describe the surgical treatment of a humerus fracture, specifically when the fracture is repaired without the need for internal fixation, such as plates or screws. This code is typically used when a physician performs a procedure to realign and stabilize the broken bone in the upper arm (humerus) using non-invasive methods like casting or splinting.
When billing for CPT code 24505, which pertains to the treatment of a humerus fracture, certain modifiers may be necessary to provide additional information about the procedure. Below is a list of potential modifiers that could be used, along with the reasons for their application:
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 other factors that made the treatment more complex.
2. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period
- Apply this modifier if an unrelated evaluation and management service is performed by the same physician during the postoperative period of the initial procedure.
3. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service
- Use this modifier if a significant, separately identifiable evaluation and management service is provided by the same physician on the same day as the procedure.
4. Modifier 50 - Bilateral Procedure
- This modifier is used if the procedure is performed on both sides of the body during the same operative session.
5. Modifier 51 - Multiple Procedures
- Apply this modifier when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
6. Modifier 52 - Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
7. Modifier 53 - Discontinued Procedure
- This modifier is used if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
8. Modifier 54 - Surgical Care Only
- Apply this modifier if the physician is providing only the surgical care portion of the procedure.
9. Modifier 55 - Postoperative Management Only
- Use this modifier if the physician is providing only the postoperative management portion of the procedure.
10. Modifier 56 - Preoperative Management Only
- This modifier is used if the physician is providing only the preoperative management portion of the procedure.
11. Modifier 57 - Decision for Surgery
- Apply this modifier if the evaluation and management service resulted in the initial decision to perform the surgery.
12. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if the procedure was planned or staged at the time of the original procedure or if it is more extensive than the original procedure.
13. Modifier 59 - Distinct Procedural Service
- This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
14. Modifier 76 - Repeat Procedure or Service by Same Physician
- Apply this modifier if the same procedure is repeated by the same physician.
15. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if the same procedure is repeated by a different physician.
16. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- This modifier is used if the patient returns to the operating room for a related procedure during the postoperative period.
17. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
18. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon is required for the procedure.
19. Modifier 81 - Minimum Assistant Surgeon
- This modifier is used if a minimum assistant surgeon is required for the procedure.
20. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier if an assistant surgeon is required because a qualified resident surgeon is not available.
21. Modifier 99 - Multiple Modifiers
- Use this modifier if multiple modifiers are necessary to describe the service provided.
These modifiers help provide a more accurate and detailed description of the services rendered, ensuring appropriate reimbursement and compliance with billing guidelines.
The CPT code 24505 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates. However, it is essential to verify the reimbursement status and any applicable conditions with your regional Medicare Administrative Contractor (MAC), as they are responsible for processing Medicare claims and can provide detailed information on coverage and payment policies for CPT code 24505.
Discover how MD Clarity's RevFind software can read your contracts and detect underpayments down to the CPT code level and by individual payer. For example, ensure you're receiving accurate payments for CPT code 24505. Schedule a demo today to see how RevFind can optimize your revenue cycle management.
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