CPT code 21034 is for the excision of a tumor from the maxilla or zygoma, which are parts of the upper jaw and cheekbone.
CPT code 21034 is used for the surgical procedure that involves the excision, or removal, of a malignant tumor located in the maxilla (upper jaw) or zygoma (cheekbone). This code specifically applies to cases where the tumor is cancerous and requires careful surgical intervention to remove it from these facial bones.
When billing for CPT code 21034 (Excision of benign tumor or cyst of maxilla or zygoma by enucleation and curettage), 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 21034, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort or complexity than typically required.
2. Modifier 50 - Bilateral Procedure
- Use this modifier if the procedure was performed on both sides of the body.
3. Modifier 51 - Multiple Procedures
- Use this modifier if multiple procedures were performed during the same surgical session.
4. Modifier 52 - Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure
- Use this modifier if the procedure was discontinued due to extenuating circumstances or those that threatened the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
7. Modifier 62 - Two Surgeons
- Use this modifier if two surgeons worked together as primary surgeons performing distinct parts of the procedure.
8. Modifier 66 - Surgical Team
- Use this modifier if the procedure required a surgical team due to its complexity.
9. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same physician performed the procedure more than once on the same day.
10. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if a different physician performed the procedure more than once on the same day.
11. 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 required an unplanned return to the operating room for a related procedure during the postoperative period.
12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if the procedure was unrelated to the original procedure and performed during the postoperative period.
13. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was required during the procedure.
14. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon was required during the procedure.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier if a non-physician provider assisted in the surgery.
Proper use of these modifiers can help ensure that claims are processed correctly and that the healthcare provider receives appropriate reimbursement for the services rendered. Always refer to the latest coding guidelines and payer-specific policies when applying modifiers.
Medicare reimbursement for CPT code 21034, which pertains to the excision of a maxillary or zygomatic malignant tumor, depends on several factors including the specific Medicare Administrative Contractor (MAC) jurisdiction, the setting in which the procedure is performed, and the patient's specific Medicare plan.
As of the latest available data, Medicare does reimburse for CPT code 21034, but the reimbursement amount can vary. For instance, in a hospital outpatient setting, the reimbursement might be different compared to an inpatient setting or an ambulatory surgical center. Additionally, the geographic location can influence the reimbursement rate due to regional adjustments.
To obtain the most accurate and current reimbursement amount, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS) or contact their local MAC. These resources will provide the specific allowable amount for CPT code 21034 based on the latest updates and regional adjustments.
In summary, while Medicare does reimburse for CPT code 21034, the exact amount can vary. Providers should consult the MPFS or their local MAC for precise figures.
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 21034 for excising maxillary or zygomatic malignant tumors. Schedule a demo today to see how RevFind can help you recover revenue from individual payers and ensure you're getting paid what you deserve.
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