CPT code 24931 is for the surgical procedure to amputate the upper arm and implant a prosthetic device.
CPT code 24935 is used to describe the surgical procedure for the revision of an amputation. This involves the modification or correction of a previously performed amputation, typically to address complications such as infection, poor healing, or to improve the functionality of a prosthetic limb. The revision may include reshaping the bone, adjusting the soft tissue, or other necessary adjustments to enhance the patient's recovery and quality of life.
When dealing with CPT code 24935, which pertains to the revision of an amputation, it is essential to consider the appropriate modifiers that may be required to provide additional information about the procedure. Below is a list of potential modifiers that could be used with CPT code 24935, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Used when the work required to perform the procedure is substantially greater than typically required.
2. Modifier 50 - Bilateral Procedure
- Applied if the revision of amputation is performed on both limbs during the same operative session.
3. Modifier 51 - Multiple Procedures
- Used when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services
- Indicates that the service provided was less than usually required for the listed procedure.
5. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
- Used if the revision is planned or staged during the postoperative period of the initial amputation.
6. Modifier 59 - Distinct Procedural Service
- Indicates that the revision of amputation is a distinct service from other procedures performed on the same day.
7. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Used if the same procedure is repeated by the same provider.
8. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Applied if the same procedure is repeated by a different provider.
9. 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 if the patient returns to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Indicates that the revision of amputation is unrelated to the original procedure and performed during the postoperative period.
11. Modifier LT - Left Side (Used to identify procedures performed on the left side of the body)
- Applied if the revision of amputation is performed on the left limb.
12. Modifier RT - Right Side (Used to identify procedures performed on the right side of the body)
- Applied if the revision of amputation is performed on the right limb.
13. Modifier 99 - Multiple Modifiers
- Used when two or more modifiers are necessary to describe the service provided.
These modifiers help provide a more detailed and accurate description of the services rendered, ensuring proper billing and reimbursement. Always consult the latest CPT coding guidelines and payer-specific requirements to confirm the appropriate use of modifiers.
The CPT code 24935 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates. Additionally, it is crucial to consult with your local Medicare Administrative Contractor (MAC) to confirm any regional variations or specific billing requirements that may apply to CPT code 24935. The MACs are responsible for processing Medicare claims and can provide detailed guidance on coverage and reimbursement policies for your specific locality.
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 24935. Ensure you're receiving the full reimbursement you deserve from each payer. Schedule a demo today to see RevFind in action and protect your revenue.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
