CPT code 20665 is for the removal of a fixation device, a procedure to take out hardware used to stabilize bones or joints.
CPT code 20665 is for the removal of a fixation device. This code is used when a healthcare provider removes a device that was previously implanted to stabilize a bone or joint, such as screws, pins, or plates.
When billing for CPT code 20665 (Removal of fixation device), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of potential modifiers that could be used with CPT code 20665, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the removal of the fixation device required significantly more effort or time than usual due to complications or other factors.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the removal of fixation devices was performed on both sides of the body during the same operative session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures, including the removal of the fixation device, are performed during the same surgical session.
4. Modifier 52 - Reduced Services
- Apply this modifier 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 removal of the fixation device was a distinct procedural service from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the removal of the fixation device was repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if the removal of the fixation device was repeated by a different physician on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Apply this modifier if the patient had to return to the operating room for the removal of the fixation device due to complications from the initial procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if the removal of the fixation device is unrelated to the original procedure and occurs during the postoperative period of the initial surgery.
10. Modifier LT - Left Side
- Apply this modifier if the removal of the fixation device was performed on the left side of the body.
11. Modifier RT - Right Side
- Use this modifier if the removal of the fixation device was performed on the right side of the body.
12. Modifier XS - Separate Structure
- Apply this modifier to indicate that the removal of the fixation device was performed on a separate anatomical structure from other procedures performed on the same day.
13. Modifier XE - Separate Encounter
- Use this modifier if the removal of the fixation device was performed during a separate encounter on the same day as other procedures.
14. Modifier XP - Separate Practitioner
- Apply this modifier if the removal of the fixation device was performed by a different practitioner than other procedures on the same day.
15. Modifier XU - Unusual Non-Overlapping Service
- Use this modifier to indicate that the removal of the fixation device was an unusual, non-overlapping service distinct from other procedures performed on the same day.
By appropriately applying these modifiers, healthcare providers can ensure accurate billing and optimize reimbursement for the removal of fixation devices.
Medicare does reimburse for CPT code 20665, which pertains to the removal of a fixation device. The reimbursement amount can vary based on several factors, including geographic location, the specific Medicare Administrative Contractor (MAC), and the setting in which the procedure is performed (e.g., hospital outpatient, ambulatory surgical center, or physician's office).
As of the most recent data, the national average reimbursement rate for CPT code 20665 under the Medicare Physician Fee Schedule (MPFS) is approximately $200. However, it is crucial to verify the exact reimbursement rate with your local MAC, as rates can fluctuate and are subject to annual updates. Additionally, ensure that all documentation and coding are accurate to avoid claim denials or delays in payment.
Discover how MD Clarity's RevFind software can read your contracts and detect underpayments down to the CPT code level and by individual payer. Ensure you're receiving full reimbursement for procedures like CPT code 20665, Removal of fixation device. Schedule a demo today to see how RevFind can optimize your revenue cycle and protect your bottom line.
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