CPT code 20690 is for applying a bone fixation device, used to stabilize bones during the healing process.
CPT code 20690 is used for the application of a bone fixation device, which typically involves the placement of pins, wires, or other hardware to stabilize a bone fracture or to correct a bone deformity. This procedure is essential for ensuring proper alignment and healing of the bone.
When using CPT code 20690 for the application of a bone fixation device, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or unusual circumstances.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the bone fixation device was applied to both sides of the body during the same operative session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session. This indicates that 20690 is one of several procedures.
4. Modifier 52 - Reduced Services
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if the application of the bone fixation device is part of a staged or related procedure during the postoperative period of the initial surgery.
6. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the procedure is distinct or independent from other services performed on the same day.
7. Modifier 76 - Repeat Procedure or Service by Same Physician
- This modifier is used if the same procedure is repeated by the same physician after the initial procedure.
8. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if the procedure is repeated by a different physician after the initial procedure.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Use this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- This modifier is used when the procedure is performed by the same physician but is unrelated to the original procedure during the postoperative period.
11. Modifier 80 - Assistant Surgeon
- Apply this modifier if an assistant surgeon was necessary for the procedure.
12. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon was required for the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Apply this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement. Always refer to the latest coding guidelines and payer-specific policies when applying modifiers.
Medicare does reimburse for CPT code 20690, which pertains to the application of a bone fixation device. The reimbursement amount can vary based on several factors, including geographic location and the specific Medicare Administrative Contractor (MAC) policies. As of the most recent data, the national average reimbursement rate for CPT code 20690 is approximately $200. However, it is crucial to verify the exact reimbursement rate with your local MAC to ensure accurate billing and reimbursement.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level and by individual payer. For instance, if you're billing for CPT code 20690 (Apply bone fixation device), RevFind ensures you're receiving the correct reimbursement. Schedule a demo today to see how RevFind can help you identify and recover underpayments efficiently.
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