CPT code 20697 is for the adjustment or replacement of an external fixation device's strut, used in orthopedic procedures.
CPT code 20697 is for the procedure involving the adjustment or replacement of struts on an external fixation device. This code is used when a healthcare provider needs to modify the external fixator, which is a medical apparatus used to stabilize and hold bones in the correct position during the healing process.
For CPT code 20697, which pertains to the "Comp ext fixate strut change," the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more work than typically required. This could be due to the complexity of the case or the patient's condition.
2. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period
- Apply this modifier if an unrelated E/M service is performed by the same physician during the postoperative period of the initial procedure.
3. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service
- Use this modifier when a significant, separately identifiable E/M service is provided by the same physician on the same day as the procedure.
4. Modifier 50 - Bilateral Procedure
- This modifier is used if the procedure is performed bilaterally (on both sides of the body).
5. Modifier 51 - Multiple Procedures
- Apply this modifier when multiple procedures are performed during the same session. It indicates that the procedure is one of several performed.
6. Modifier 52 - Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
7. Modifier 53 - Discontinued Procedure
- This modifier is used if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
8. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if the procedure was planned prospectively or at the time of the original procedure, or if it is more extensive than the original procedure, or for therapy following a surgical procedure.
9. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day.
10. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- This modifier is used if the same procedure is repeated by the same physician.
11. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Apply this modifier if the same procedure is repeated by a different physician.
12. 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.
13. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- This modifier is used if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
14. Modifier 80 - Assistant Surgeon
- Apply this modifier if an assistant surgeon is required for the procedure.
15. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon is required for the procedure.
16. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- This modifier is used if an assistant surgeon is required because a qualified resident surgeon is not available.
17. Modifier 99 - Multiple Modifiers
- Apply this modifier if multiple modifiers are necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement. Proper use of modifiers can help avoid claim denials and ensure that healthcare providers are compensated correctly for the services they provide.
When considering whether Medicare reimburses for CPT code 20697, which pertains to the "Comp ext fixate strut change," it is essential to consult the Medicare Physician Fee Schedule (MPFS) and Local Coverage Determinations (LCDs) for the most accurate and up-to-date information.
As of the latest available data, CPT code 20697 is generally reimbursed by Medicare, provided that the procedure meets the medical necessity criteria outlined by Medicare guidelines. The reimbursement amount can vary based on geographic location, the specific Medicare Administrative Contractor (MAC), and other factors such as the facility setting (e.g., hospital outpatient department vs. physician's office).
For precise reimbursement rates, healthcare providers should refer to the MPFS Look-Up Tool available on the Centers for Medicare & Medicaid Services (CMS) website or consult their local MAC. As an example, the national average reimbursement rate for CPT code 20697 might be approximately $200-$300, but this figure can fluctuate.
To ensure compliance and accurate billing, it is advisable to verify the specific coverage policies and reimbursement rates with your local MAC and review any relevant LCDs that may apply to this procedure.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 20697 for complex external fixation strut changes. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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