Summary & Overview
CPT 24579: Open Treatment of Humeral Condyle Fracture
CPT code 24579 denotes open surgical treatment for a fracture of the humeral condyle, a key orthopedic procedure to restore elbow joint stability and function. Nationally, this code captures operative management where direct visualization and fixation (for example, plates, screws, or pins) are used to reduce condylar fractures of the distal humerus. It is clinically important because timely, appropriate surgical fixation affects long-term joint mechanics, pain, and return to activity.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for coding and billing this operative fracture service, typical sites of service, and the kinds of benchmarks and policy issues that commonly affect reimbursement for open fracture fixation. The publication outlines expected service components, common payer considerations, and where to look for updates in coverage policies or coding guidance. Data not available in the input will be noted where relevant.
Billing Code Overview
CPT code 24579 describes an open treatment of a fracture of the condyle of the humerus. The procedure involves a surgical incision at the upper arm to directly visualize and reduce the fractured condylar fragments; internal fixation devices may be applied to stabilize the distal humerus during healing.
Service Type: Open surgical fracture treatment (orthopedic procedure)
Typical Site of Service: Hospital operating room or ambulatory surgical center, with postoperative care often provided in an inpatient or outpatient orthopedic setting.
Clinical & Coding Specifications
Clinical Context
A 42-year-old male presents to the Emergency Department after a fall onto his outstretched hand with immediate elbow pain, swelling, and limited range of motion. Radiographs and CT confirm a displaced lateral condyle fracture of the distal humerus. After neurovascular assessment and splinting in the ED, the orthopedic trauma team schedules an urgent open reduction and internal fixation. In the operating room under general anesthesia, the surgeon makes a lateral incision, exposes the fracture, achieves anatomic reduction, and secures fixation with screws and a contoured plate. Postoperative care includes neurovascular checks, pain control, immobilization in a posterior splint, and early outpatient follow-up with radiographs to monitor healing and hardware position. Typical site of service is an inpatient or outpatient hospital operating room; anesthesia services and possible post-anesthesia recovery are involved. Usual providers include orthopedic surgeons with trauma or upper extremity specialization and supporting perioperative staff.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When work is substantially greater than typical for 24579, documented with operative complexity and time |