CPT code 24579 is used for the surgical treatment of a humerus fracture, detailing the specific procedure performed by the healthcare provider.
CPT code 24579 is used to describe the surgical treatment of a humerus fracture. This code specifically refers to the procedure where a surgeon repairs a broken upper arm bone (humerus) using internal fixation, which typically involves the use of metal plates, screws, or rods to stabilize the bone and ensure proper healing. This code is essential for accurate billing and documentation of the surgical intervention required to treat this type of fracture.
When billing for CPT code 24579, which is used for the treatment of a humerus fracture, it is important to consider the appropriate modifiers that may be required to ensure accurate and complete claims submission. Below is a list of potential modifiers that could be used with CPT code 24579, along with the reasons for their use:
1. Modifier 22 (Increased Procedural Services): Used when the work required to provide a service is substantially greater than typically required. This could apply if the treatment of the humerus fracture was more complex than usual.
2. Modifier 24 (Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period): Used if an evaluation and management service was performed during the postoperative period of the initial procedure but 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 if a significant, separately identifiable evaluation and management service was provided on the same day as the procedure.
4. Modifier 50 (Bilateral Procedure): Used if the procedure was performed on both sides of the body.
5. Modifier 51 (Multiple Procedures): Used when multiple procedures are performed during the same surgical 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 the physician performs the surgical procedure only and another provider is responsible for preoperative and postoperative care.
9. Modifier 55 (Postoperative Management Only): Used when the physician provides only the postoperative care.
10. Modifier 56 (Preoperative Management Only): Used when the physician provides only the preoperative care.
11. Modifier 57 (Decision for Surgery): Used when an 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): Used for a staged or related procedure during the postoperative period of the initial procedure.
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 of the initial procedure.
17. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Used when an unrelated procedure 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 provided.
By understanding and appropriately applying these modifiers, healthcare providers can ensure accurate billing and optimal reimbursement for the treatment of humerus fractures.
The CPT code 24579 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 for CPT code 24579 may vary based on the region, as Medicare Administrative Contractors (MACs) have the authority to make local coverage determinations. Therefore, it is advisable to consult the relevant MAC for your area to confirm the reimbursement details for CPT code 24579.
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