How To Use CPT Code 24516

CPT code 24516 describes the treatment of a humeral shaft fracture, with the insertion of an intramedullary implant, with or without cerclage and/or locking screws. 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 24516?

CPT 24516 is used to describe the treatment of a humeral shaft fracture. The procedure involves the insertion of an intramedullary implant, such as a rod, into the fractured bone to stabilize it. The provider may also use cerclage wires or locking screws for additional fixation, if necessary.

2. Official Description

The official description of CPT code 24516 is: ‘Treatment of humeral shaft fracture, with insertion of intramedullary implant, with or without cerclage and/or locking screws.’

3. Procedure

The procedure for CPT 24516 involves several steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision in the skin over the fractured bone.
3. The provider dissects down through the subcutaneous tissue, protecting the nerves and vessels.
4. The muscles are retracted to gain adequate exposure of the humeral shaft fracture.
5. The provider adjusts the bone to reduce the fractured fragments.
6. An intramedullary rod is pushed through the fracture bone to stabilize the fracture.
7. Additional fixation may be added using locking screws or cerclage wires.
8. The alignment is checked using imaging.
9. The area is irrigated, bleeding is checked, instruments are removed, and the incision is closed.

4. Qualifying circumstances

CPT 24516 is used for the treatment of a humeral shaft fracture. This code is appropriate when the provider uses an intramedullary implant, with or without cerclage and/or locking screws, to stabilize the fracture. The procedure is typically performed by an orthopedic surgeon or a qualified healthcare professional with expertise in fracture treatment.

5. When to use CPT code 24516

CPT code 24516 should be used when a patient undergoes treatment for a humeral shaft fracture using an intramedullary implant. The code covers the insertion of the implant, as well as any additional fixation with cerclage wires or locking screws. It is important to ensure that the documentation supports the use of this code and accurately describes the procedure performed.

6. Documentation requirements

To support a claim for CPT code 24516, the provider must document the following information:

• Patient’s diagnosis of a humeral shaft fracture
• Details of the procedure, including the use of an intramedullary implant, cerclage wires, and/or locking screws
• Date of the procedure
• Start and end time of the procedure
• Any additional fixation techniques used
• Imaging findings and confirmation of fracture reduction
• Any complications or unexpected events during the procedure
• Post-procedure instructions and follow-up plans
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 24516, it is important to ensure that the documentation supports the use of this code and accurately describes the procedure performed. The provider should be an orthopedic surgeon or a qualified healthcare professional with expertise in fracture treatment. It is also important to follow any specific billing guidelines provided by the payer or Medicare to ensure proper reimbursement.

8. Historical information

CPT code 24516 was added to the Current Procedural Terminology system on January 1, 1993. There have been no updates or changes to the code since its addition.

9. Similar codes to CPT 24516

There are several similar codes to CPT 24516 that describe different procedures for the treatment of humeral shaft fractures. These include:

• CPT 24500: Treatment of humeral shaft fracture with manipulation
• CPT 24505: Treatment of humeral shaft fracture with external fixation
• CPT 24530: Treatment of humeral shaft fracture with plate and screws
• CPT 24535: Treatment of humeral shaft fracture with intramedullary implant and plate and screws
• CPT 24538: Treatment of humeral shaft fracture with intramedullary implant, with or without cerclage and/or locking screws, and plate and screws

9. Examples

1. An orthopedic surgeon performs CPT code 24516 to treat a humeral shaft fracture in a patient. The surgeon inserts an intramedullary rod and uses locking screws for additional fixation.
2. A qualified healthcare professional with expertise in fracture treatment performs CPT code 24516 on a patient with a humeral shaft fracture. The professional uses an intramedullary implant and cerclage wires to stabilize the fracture.
3. An orthopedic surgeon uses CPT code 24516 to treat a humeral shaft fracture in a patient. The surgeon inserts an intramedullary rod without the need for additional fixation.
4. A qualified healthcare professional performs CPT code 24516 on a patient with a humeral shaft fracture. The professional uses an intramedullary implant and locking screws for additional fixation.
5. An orthopedic surgeon performs CPT code 24516 on a patient with a humeral shaft fracture. The surgeon uses an intramedullary rod and cerclage wires for additional fixation.
6. A qualified healthcare professional with expertise in fracture treatment uses CPT code 24516 to treat a humeral shaft fracture in a patient. The professional inserts an intramedullary implant without the need for additional fixation.
7. An orthopedic surgeon performs CPT code 24516 on a patient with a humeral shaft fracture. The surgeon uses an intramedullary rod and locking screws for additional fixation.
8. A qualified healthcare professional with expertise in fracture treatment uses CPT code 24516 to treat a humeral shaft fracture in a patient. The professional inserts an intramedullary implant and cerclage wires for additional fixation.