CPT code 24650 is for treating a radius fracture, detailing the specific medical procedure used to repair the broken bone in the forearm.
CPT code 24655 is used to describe the surgical treatment of a fracture in the radius, which is one of the two bones in the forearm. This code specifically refers to the procedure where the fracture is repaired without the need for an open incision, typically using methods such as manipulation or closed reduction. This ensures that the bone is properly aligned and stabilized to promote healing.
When billing for CPT code 24655 (Treatment of radial shaft fracture, with or without internal or external fixation), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer guidelines. Below is a list of potential modifiers that could be used with CPT code 24655, 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. Documentation must support the increased complexity or difficulty.
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):
- Apply this modifier if the procedure is performed bilaterally. Note that not all procedures are eligible for bilateral billing, so verify payer-specific guidelines.
5. Modifier 51 (Multiple Procedures):
- Use this modifier when multiple procedures are performed during the same surgical session. This helps indicate that more than one procedure was performed.
6. Modifier 52 (Reduced Services):
- Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
7. Modifier 53 (Discontinued Procedure):
- Use this modifier if the procedure was 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 care.
10. Modifier 56 (Preoperative Management Only):
- Apply this modifier if the physician is providing only the preoperative management portion of the care.
11. Modifier 59 (Distinct Procedural Service):
- Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day.
12. Modifier 76 (Repeat Procedure or Service by Same Physician):
- Apply this modifier if the same procedure is repeated by the same physician.
13. Modifier 77 (Repeat Procedure by Another Physician):
- Use this modifier if the same procedure is repeated by a different physician.
14. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period):
- Apply this modifier if the patient returns to the operating room for a related procedure during the postoperative period.
15. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period):
- Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period.
16. Modifier 80 (Assistant Surgeon):
- Apply this modifier if an assistant surgeon was necessary for the procedure.
17. Modifier 81 (Minimum Assistant Surgeon):
- Use this modifier if a minimum assistant surgeon was required.
18. 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.
19. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery):
- Use this modifier when a PA, NP, or CNS assists in the surgery.
Each modifier serves a specific purpose and should be used accurately to reflect the services provided. Proper documentation is crucial to support the use of these modifiers and ensure compliance with payer requirements.
The CPT code 24655 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and consult with your regional Medicare Administrative Contractor (MAC). The MPFS provides detailed information on the reimbursement rates and guidelines for various CPT codes, including 24655. Additionally, MACs can offer region-specific insights and any additional requirements or documentation needed for successful reimbursement. Always ensure to stay updated with the latest MPFS and MAC guidelines to optimize your revenue cycle management processes.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level and by individual payer. For instance, if you're billing for CPT code 24655, RevFind can identify discrepancies and ensure you're receiving the full reimbursement you deserve. Schedule a demo today to see how RevFind can enhance your revenue cycle management.
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