CPT code 20692 is for applying a bone fixation device, used to stabilize broken bones during the healing process.
CPT code 20692 is used for the application of a bone fixation device, which is a procedure where a healthcare provider attaches a device to stabilize and hold broken bones in place to ensure proper healing.
When using CPT code 20692 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 the patient's condition.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the bone fixation device is 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 20692 is one of several procedures.
4. Modifier 52 - Reduced Services
- Apply this modifier if the procedure was 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
- Use 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
- Apply 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 or Other Qualified Health Care Professional
- Use this modifier if the same procedure is repeated by the same physician or healthcare professional.
8. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Apply this modifier if the procedure is repeated by a different physician or healthcare professional.
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
- Apply this modifier if the procedure is unrelated to the original surgery and occurs during the postoperative period.
11. Modifier LT - Left Side
- Use this modifier to indicate that the procedure was performed on the left side of the body.
12. Modifier RT - Right Side
- Apply this modifier to indicate that the procedure was performed on the right side of the body.
13. Modifier 99 - Multiple Modifiers
- Use this modifier when more than four modifiers are necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement. Always refer to the latest CPT coding guidelines and payer-specific requirements for the most accurate and up-to-date information.
Medicare does reimburse for CPT code 20692, 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 latest data, the national average reimbursement for CPT code 20692 is approximately $500. However, it is essential to verify the exact reimbursement rate with your local MAC, as rates can fluctuate and may be subject to updates. Always ensure that the procedure is medically necessary and properly documented to meet Medicare's coverage criteria.
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