CPT code 24620 is a medical code used to describe the treatment of an elbow fracture.
CPT code 24635 is used to describe the surgical treatment of an elbow fracture. This code specifically refers to the procedure where a healthcare provider performs an open treatment of an elbow fracture, which may involve the use of internal fixation devices such as screws or plates to stabilize the bone. This type of procedure is typically necessary when the fracture is severe or cannot be properly aligned through non-surgical methods.
When billing for CPT code 24635 (Treatment of elbow 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 modifiers that could be used with CPT code 24635, 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 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period
- Apply this modifier if an unrelated E/M 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 when a significant, separately identifiable E/M 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 elbows 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
- Apply this modifier 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
- Use this modifier if the physician is providing only the surgical care portion of the procedure.
9. Modifier 55 - Postoperative Management Only
- Apply this modifier if the physician is providing only the postoperative care for the procedure.
10. Modifier 56 - Preoperative Management Only
- Use this modifier if the physician is providing only the preoperative care for the procedure.
11. Modifier 57 - Decision for Surgery
- Apply this modifier if the E/M 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 is more extensive than the original procedure.
13. Modifier 59 - Distinct Procedural Service
- Apply this modifier to indicate that the procedure is distinct or independent from other services performed on the same day.
14. Modifier 76 - Repeat Procedure or Service by Same Physician
- Use this modifier if the same procedure is repeated by the same physician.
15. Modifier 77 - Repeat Procedure by Another Physician
- Apply 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
- Use this modifier if the patient requires an unplanned return 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.
18. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon is required for the procedure.
19. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon is required for the procedure.
20. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon is required because a qualified resident surgeon is not available.
21. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Apply this modifier if a PA, NP, or CNS assists in the surgery.
22. Modifier LT - Left Side (used to identify procedures performed on the left side of the body)
- Use this modifier if the procedure is performed on the left elbow.
23. Modifier RT - Right Side (used to identify procedures performed on the right side of the body)
- Apply this modifier if the procedure is performed on the right elbow.
Each modifier serves a specific purpose and should be used appropriately to reflect the circumstances of the procedure accurately. Proper documentation is crucial to support the use of any modifier.
The CPT code 24635 is reimbursed by Medicare, but it is essential to verify its inclusion in the Medicare Physician Fee Schedule (MPFS) for the specific year in question. The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates. Additionally, reimbursement for CPT code 24635 may vary depending 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 specific reimbursement details for CPT code 24635.
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