CPT code 20251 is for an open bone biopsy, a procedure where a sample of bone tissue is surgically removed for examination.
CPT code 20251 is for an open bone biopsy, which is a procedure where a surgeon makes an incision to access and remove a small sample of bone tissue for examination. This is typically done to diagnose conditions such as infections, bone diseases, or cancers.
For CPT code 20251 (Open bone biopsy), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort than typically required. Documentation must support the substantial additional work.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the open bone biopsy was performed on both sides of the body during the same session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures, other than E/M services, are performed at the same session by the same provider.
4. Modifier 52 - Reduced Services
- This modifier is applicable if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Apply this modifier if the same procedure was repeated by the same provider on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Use this modifier if the same procedure was repeated by a different provider on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period
- This modifier is used if the patient returns to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
- Apply this modifier if an unrelated procedure is performed by the same provider during the postoperative period of the initial procedure.
10. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon was required during the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery
- This modifier is used when a non-physician provider assists in the surgery.
Each modifier serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies. Proper use of modifiers ensures accurate billing and reimbursement for the services provided.
Medicare does reimburse for CPT code 20251, which is used for an open bone biopsy. The reimbursement amount can vary based on several factors, including geographic location and the specific Medicare Administrative Contractor (MAC) overseeing the claim. As of the latest data, the national average reimbursement for CPT code 20251 is approximately $500. However, it is essential to verify the exact reimbursement rate with your local MAC or through the Medicare Physician Fee Schedule (MPFS) for the most accurate and up-to-date information.
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