How To Use CPT Code 24515

CPT code 24515 describes the open treatment of a fracture of the humeral shaft, which is the bone in the upper arm. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 24515?

CPT 24515 is used to describe the open treatment of a fracture of the humeral shaft. This procedure involves making an incision over the arm to access the fracture and then securing it with wires and screws. The provider may also use a technique called cerclage, which involves encircling the bone with wire to hold the ends together.

2. Official Description

The official description of CPT code 24515 is: ‘Open treatment of humeral shaft fracture with plate/screws, with or without cerclage.’

3. Procedure

During the procedure for CPT 24515, the provider begins by making an incision in the skin over the fractured bone. They then dissect through the subcutaneous tissue, being careful to protect the nerves and vessels. The muscles are retracted to gain adequate exposure of the humeral shaft fracture. The provider adjusts the bone to reduce the fractured fragments and stabilizes the repair with a plate and screws. They may also apply wire rings for additional fixation. The alignment of the bone is checked using imaging. After irrigating the area and checking for bleeding, the provider removes any instruments and closes the incision.

4. Qualifying circumstances

CPT 24515 is used for patients who have a fracture of the humeral shaft that requires open treatment. This procedure is typically performed when the fracture cannot be adequately treated with non-surgical methods, such as casting or splinting. The patient must meet the criteria for open treatment, and the provider must determine that this is the most appropriate course of action for the patient’s specific fracture.

5. When to use CPT code 24515

CPT code 24515 should be used when the provider performs open treatment of a fracture of the humeral shaft using plates and screws, with or without cerclage. This code should not be used for other types of fractures or for different treatment methods. It is important to accurately document the procedure performed to ensure proper coding and billing.

6. Documentation requirements

To support a claim for CPT 24515, the provider must document the following information:

• Patient’s diagnosis of a fracture of the humeral shaft
• Details of the open treatment procedure performed, including the use of plates, screws, and cerclage if applicable
• Date of the procedure
• Start and end time of the procedure
• Any additional procedures or techniques used during the treatment
• Any complications or unexpected findings
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 24515, ensure that the procedure meets the criteria for open treatment of a fracture of the humeral shaft using plates and screws, with or without cerclage. It is important to accurately document the procedure and any additional techniques used. Modifier 57, Decision for surgery, may be used if an evaluation and management (E/M) service resulted in the decision for surgery. It is also important to follow any specific billing guidelines provided by the payer.

8. Historical information

CPT 24515 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 24515

Five similar codes to CPT 24515 include:

• CPT 24516: Open treatment of humeral shaft fracture with plate/screws, with or without cerclage, with insertion of bone graft
• CPT 24517: Open treatment of humeral shaft fracture with plate/screws, with or without cerclage, with insertion of intramedullary implant
• CPT 24530: Closed treatment of humeral shaft fracture; without manipulation
• CPT 24535: Closed treatment of humeral shaft fracture; with manipulation
• CPT 24538: Percutaneous skeletal fixation of humeral shaft fracture, proximal end, with or without cerclage and/or locking screws

9. Examples

1. A patient sustains a fracture of the humeral shaft and undergoes open treatment with plates and screws, without the use of cerclage.
2. A provider performs open treatment of a humeral shaft fracture using plates, screws, and cerclage to stabilize the fracture.
3. A patient with a complex humeral shaft fracture undergoes open treatment with plates, screws, and bone grafting to promote healing.
4. A provider performs open treatment of a humeral shaft fracture using plates, screws, and an intramedullary implant for additional stability.
5. A patient presents with a humeral shaft fracture that requires closed treatment without manipulation.
6. A provider performs closed treatment of a humeral shaft fracture with manipulation to realign the fractured fragments.
7. A patient with a proximal humeral shaft fracture undergoes percutaneous skeletal fixation with the use of cerclage and locking screws.
8. A provider performs open treatment of a humeral shaft fracture using plates, screws, and bone grafting, with the additional use of an intramedullary implant.
9. A patient sustains a humeral shaft fracture and undergoes closed treatment without manipulation, followed by physical therapy for rehabilitation.
10. A provider performs closed treatment of a humeral shaft fracture with manipulation, followed by the application of a cast for immobilization.