CPT code 20987 is used for computer-assisted musculoskeletal procedure imaging.
CPT code 20987 is used for computer-assisted surgical navigation procedures that involve the use of preoperative imaging. This code is specifically for procedures where the surgeon uses computer technology to guide the surgery based on images taken before the operation.
For CPT code 20987, which pertains to computer-assisted musculoskeletal surgical navigation based on preoperative imaging, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to provide a service is substantially greater than typically required. For instance, if the complexity of the navigation process is significantly higher due to patient-specific factors, Modifier 22 can be appended.
2. Modifier 26 (Professional Component): This modifier is used when only the professional component of the service is being billed. For example, if the physician is only interpreting the preoperative imaging and not providing the equipment or technical support, Modifier 26 should be used.
3. Modifier 52 (Reduced Services): This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. If the computer-assisted navigation was not fully utilized or only partially completed, Modifier 52 would be appropriate.
4. Modifier 59 (Distinct Procedural Service): This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. If the computer-assisted navigation is performed in conjunction with another procedure but is distinct and separate, Modifier 59 should be used.
5. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used when a procedure or service is repeated by the same physician. If the computer-assisted navigation needs to be repeated during the same operative session, Modifier 76 would be applicable.
6. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when a procedure or service is repeated by another physician. If another physician needs to repeat the computer-assisted navigation, Modifier 77 should be used.
7. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): This modifier is used when a patient returns to the operating room for a related procedure during the postoperative period. If the computer-assisted navigation is required again due to complications or additional surgical needs, Modifier 78 would be appropriate.
8. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period. If the computer-assisted navigation is performed for an unrelated issue, Modifier 79 should be used.
9. Modifier 80 (Assistant Surgeon): This modifier is used when an assistant surgeon is required for the procedure. If an assistant surgeon is necessary for the computer-assisted navigation, Modifier 80 should be appended.
10. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available. If this situation applies, Modifier 82 should be used.
11. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery. If such a professional assists with the computer-assisted navigation, Modifier AS should be appended.
These modifiers help provide additional context and specificity to the billing of CPT code 20987, ensuring accurate and appropriate reimbursement for the services rendered.
Determining whether a specific CPT code, such as 20987 (Cptr-asst dir ms px pre img), is reimbursed by Medicare involves checking the Medicare Physician Fee Schedule (MPFS) and other relevant Medicare guidelines.
As of the latest updates, CPT code 20987 is not commonly listed in the Medicare Physician Fee Schedule, indicating that it may not be reimbursed by Medicare. However, reimbursement policies can vary based on specific circumstances, including the medical necessity of the procedure and the setting in which it is performed.
For the most accurate and up-to-date information, healthcare providers should consult the MPFS directly or use the Medicare Administrative Contractor (MAC) resources. Additionally, contacting Medicare directly or using their online tools can provide specific reimbursement amounts if applicable.
In summary, CPT code 20987 is generally not reimbursed by Medicare, but providers should verify this through official Medicare resources to ensure compliance and accurate billing.
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