Summary & Overview
CPT 24435: Humerus Osteotomy with Autologous Bone Graft
CPT code 24435 represents a corrective surgical procedure for nonunion or malunion of the humerus that combines osteotomy, internal fixation, and autologous bone grafting. This code captures complex reconstructive upper-extremity surgery aimed at restoring alignment and function when fractures have failed to heal properly or have healed in a deformity. Nationally, the procedure is significant for orthopedic trauma, reconstructive surgery, and care pathways that impact inpatient and ambulatory surgical utilization and resource intensity.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn clinical context for use of the code, typical sites of service, common billing considerations, and benchmarking information where available. The content summarizes how this code is used in practice, how it relates to surgical service lines, and what types of clinical scenarios generally prompt billing under this code.
Sections that follow provide the operative description and service setting, the range of modifiers and billing considerations (Data not available in the input), and guidance on mapping to clinical documentation and diagnosis capture. Data not available in the input is clearly noted where applicable.
Billing Code Overview
CPT code 24435 describes an operative procedure to correct a nonunion or malunion deformity of the upper arm (humerus) by performing an osteotomy and securing the bone with internal fixation combined with an autologous bone graft harvested from the patient. The procedure addresses improperly healed or undeveloped bone to restore alignment, stability, and function.
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Service type: Surgical procedure — corrective osteotomy with internal fixation and autologous bone grafting
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Typical site of service: Inpatient or outpatient hospital operating room, or ambulatory surgery center, depending on patient complexity and perioperative needs
Clinical & Coding Specifications
Clinical Context
A 45-year-old male presents with persistent pain, limited range of motion, and functional impairment of the right upper arm six months after an initial midshaft humeral fracture that failed to heal. Radiographs and CT demonstrate a symptomatic nonunion with shortening and varus malalignment. The orthopedic surgeon plans an open corrective osteotomy with debridement of fibrous tissue, autogenous iliac crest bone grafting, and internal fixation (plate and screws) to restore alignment and promote union. Preoperative workflow includes imaging review, informed consent, anesthesia evaluation (general or regional), blood type/screen if indicated, and operative consent for possible bone graft harvest from the iliac crest. Intraoperative steps include exposure of the nonunion site, removal of interposed tissue, osteotomy or freshening of bone ends, placement of autologous corticocancellous graft, reduction, and rigid fixation. Postoperative care includes pain control, immobilization or limited motion protocol, wound checks, and serial radiographs to document progressive union. Typical sites of service are an inpatient surgical unit, outpatient hospital operating room, or ambulatory surgical center depending on clinical complexity and comorbidities. Typical payer interactions follow standard preauthorization workflows with payors such as Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, and intensity significantly exceed the usual for the procedure (document justification). |