CPT code 24565 is for the surgical treatment of a humerus fracture, involving the repair or fixation of the upper arm bone.
CPT code 24565 is used to describe the surgical treatment of a humerus fracture, specifically when the procedure involves the use of internal fixation. This means that the surgeon will use hardware such as plates, screws, or rods to stabilize and align the broken bone, ensuring proper healing and function. This code is essential for accurate billing and documentation of the specific type of fracture treatment provided.
When billing for CPT code 24565, which pertains to the treatment of a humerus fracture, the following modifiers may be applicable depending on the specific circumstances of the treatment:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required.
2. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: Used when an evaluation and management service provided during a postoperative period is unrelated to the original 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: Used when a significant, separately identifiable evaluation and management service is performed on the same day as the procedure.
4. Modifier 50 - Bilateral Procedure: Used when the same procedure is performed on both sides of the body.
5. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same session.
6. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
7. Modifier 53 - Discontinued Procedure: Used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
8. Modifier 54 - Surgical Care Only: Used when only the surgical care portion of a service is provided.
9. Modifier 55 - Postoperative Management Only: Used when only the postoperative care portion of a service is provided.
10. Modifier 56 - Preoperative Management Only: Used when only the preoperative care portion of a service is provided.
11. Modifier 57 - Decision for Surgery: Used when an evaluation and management service results in the initial decision to perform surgery.
12. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: Used when a procedure or service during the postoperative period was planned or anticipated.
13. Modifier 59 - Distinct Procedural Service: 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: Used when a procedure or service is repeated by the same physician.
15. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another 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: Used when a related procedure is performed during the postoperative period.
17. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure or service is performed by the same physician during the postoperative period.
18. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
19. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
20. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required and a qualified resident surgeon is not available.
21. Modifier 99 - Multiple Modifiers: Used when two or more modifiers are necessary to describe the service.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement for the services provided.
CPT code 24565 is reimbursed by Medicare, but the reimbursement specifics can vary. To determine the exact reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered by Medicare. Additionally, it is essential to consult with your regional Medicare Administrative Contractor (MAC) for any local coverage determinations or specific billing guidelines that may affect reimbursement for CPT code 24565. The MACs are responsible for processing Medicare claims and can provide valuable insights into any regional variations or additional documentation requirements.
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