How To Use CPT Code 24575

CPT code 24575 describes the open treatment of a humeral epicondylar fracture, whether it is medial or lateral, and includes internal fixation if performed. 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 24575?

CPT 24575 is used to describe the open treatment of a humeral epicondylar fracture, which can occur on either the medial or lateral side of the elbow. This procedure involves making an incision in the arm to access the fractured bone and may include the use of hardware, such as plates, screws, wires, or pins, to stabilize the fracture during the healing process.

2. Official Description

The official description of CPT code 24575 is: ‘Open treatment of humeral epicondylar fracture, medial or lateral, includes internal fixation, when performed.’

3. Procedure

During the procedure for CPT 24575, the healthcare provider begins by making an incision in the skin over the fractured bone. They carefully dissect through the subcutaneous tissue, ensuring the protection of nerves and blood vessels. The provider then retracts the muscles to gain adequate exposure of the medial or lateral humeral epicondylar fracture. The bone is adjusted to reduce the fracture, and if necessary, hardware such as plates, screws, wires, or pins may be applied to stabilize the reduction. The alignment of the bone is checked using imaging techniques. After irrigating the area and ensuring there is no bleeding, the provider removes any instruments and closes the incision. A splint or brace may be applied to support the healing process.

4. Qualifying circumstances

CPT 24575 is used for patients who have a humeral epicondylar fracture, whether it is on the medial or lateral side of the elbow. The procedure is performed in an open surgical manner and may include internal fixation using hardware. The decision to use CPT 24575 is based on the specific diagnosis and the need for surgical intervention to treat the fracture.

5. When to use CPT code 24575

CPT code 24575 should be used when a healthcare provider performs an open treatment of a humeral epicondylar fracture, whether it is medial or lateral, and includes internal fixation if performed. This code should not be used for other types of fractures or procedures that do not involve the humeral epicondyle.

6. Documentation requirements

To support a claim for CPT 24575, the healthcare provider must document the following information:

• Patient’s diagnosis of a humeral epicondylar fracture
• Details of the procedure performed, including the approach used (medial or lateral), any internal fixation performed, and any additional procedures or techniques used
• Date of the procedure
• Start and end time of the procedure
• Any complications or unexpected findings during the procedure
• Post-operative care instructions and any follow-up appointments scheduled
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 24575, ensure that the procedure performed matches the description of the code. The use of internal fixation should be documented if performed. It is important to follow any specific billing guidelines provided by the payer or Medicare to ensure accurate reimbursement. Modifier 57, Decision for surgery, may be used if the procedure was preceded by an evaluation and management (E/M) service that resulted in the decision for surgery.

8. Historical information

CPT 24575 was added to the Current Procedural Terminology system on January 1, 1990. On January 1, 2008, the code description was updated to include the option for internal or external fixation.

9. Similar codes to CPT 24575

There are several similar codes to CPT 24575 that describe different procedures or fractures. Some examples include:

• CPT 24576: Open treatment of humeral epicondylar fracture, medial or lateral, with or without internal or external fixation
• CPT 24577: Percutaneous skeletal fixation of humeral epicondylar fracture, medial or lateral
• CPT 24579: Closed treatment of humeral epicondylar fracture, medial or lateral
• CPT 24586: Open treatment of supracondylar humeral fracture with or without internal or external fixation
• CPT 24587: Percutaneous skeletal fixation of supracondylar humeral fracture

9. Examples

1. A patient sustains a medial humeral epicondylar fracture and undergoes open treatment with internal fixation using plates and screws.
2. A patient presents with a lateral humeral epicondylar fracture and undergoes open treatment with internal fixation using wires.
3. A healthcare provider performs open treatment of a medial humeral epicondylar fracture without the need for internal fixation.
4. An individual fractures their lateral humeral epicondyle and undergoes open treatment with external fixation using pins.
5. A patient requires open treatment of a medial humeral epicondylar fracture with both internal and external fixation.
6. A lateral humeral epicondylar fracture is treated with open reduction and internal fixation using plates and screws.
7. A healthcare provider performs open treatment of a medial humeral epicondylar fracture with internal fixation using a combination of wires and screws.
8. An individual sustains a lateral humeral epicondylar fracture and undergoes open treatment without the need for internal or external fixation.
9. A patient presents with a medial humeral epicondylar fracture and undergoes open treatment with internal fixation using a combination of plates and wires.
10. A healthcare provider performs open treatment of a lateral humeral epicondylar fracture with internal fixation using screws.