CPT code 24535 is a medical code used to describe the treatment of a humerus fracture.
CPT code 24535 is used to describe the surgical treatment of a humerus fracture, specifically when the procedure involves open treatment with internal fixation. This means that the surgeon makes an incision to access the broken bone and uses hardware, such as plates, screws, or rods, to stabilize and align the bone for proper healing. This code is essential for accurately documenting and billing for the surgical repair of a humerus fracture.
When billing for CPT code 24535, which pertains to the treatment of a humerus fracture, 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 24535, 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. This could be due to factors such as the complexity of the fracture or patient-specific complications.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both humeri during the same surgical session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session. This indicates that CPT code 24535 is one of several procedures performed.
4. Modifier 52 - Reduced Services
- This modifier is appropriate if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure
- Use this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 54 - Surgical Care Only
- Apply this modifier if the physician is providing only the surgical care portion of the procedure, with another provider handling preoperative and postoperative care.
7. Modifier 55 - Postoperative Management Only
- Use this modifier if the physician is providing only the postoperative care, with another provider having performed the surgical procedure.
8. Modifier 56 - Preoperative Management Only
- This modifier is used if the physician is providing only the preoperative care, with another provider performing the surgery and postoperative care.
9. 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.
10. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same physician needs to repeat the procedure on the same day.
11. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is appropriate if a different physician repeats the procedure on the same day.
12. 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 requires an unplanned return to the operating room for a related procedure during the postoperative period.
13. 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.
14. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was necessary for the procedure.
15. Modifier 81 - Minimum Assistant Surgeon
- This modifier is used if a minimum assistant surgeon was required for the procedure.
16. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier if an assistant surgeon was necessary because a qualified resident surgeon was not available.
17. 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.
By appropriately applying these modifiers, healthcare providers can ensure accurate billing and optimal reimbursement for the treatment of a humerus fracture under CPT code 24535.
The CPT code 24535 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, including the reimbursement rates for each CPT code. Additionally, MACs are responsible for processing Medicare claims and can offer detailed guidance on coverage and reimbursement policies specific to your region. Therefore, while CPT code 24535 is generally reimbursed, it is advisable to consult both the MPFS and your MAC for precise information and any potential regional variations.
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 24535. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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