CPT code 21110 is for interdental fixation, a procedure used to stabilize teeth, often in the context of jaw fractures or dental surgeries.
CPT code 21110 is used for the procedure known as interdental fixation. This involves the stabilization of teeth, typically using wires or other devices, to maintain proper alignment and support during the healing process after a dental or jaw injury.
When billing for CPT code 21110 (Interdental fixation), it is essential to consider the appropriate modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of potential modifiers that could be used with CPT code 21110, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more work than typically required. Documentation must support the additional effort.
2. Modifier 50 - Bilateral Procedure
- If the interdental fixation procedure is performed bilaterally, this modifier indicates that the procedure was done on both sides.
3. Modifier 51 - Multiple Procedures
- Apply this modifier when multiple procedures are performed during the same surgical session. This helps in identifying that more than one procedure was carried out.
4. Modifier 52 - Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion. Documentation should support the reduction in services.
5. Modifier 59 - Distinct Procedural Service
- This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day. It helps in avoiding bundling issues.
6. Modifier 76 - Repeat Procedure by Same Physician
- If the same procedure is repeated by the same physician, this modifier should be used to indicate the repeat service.
7. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if the procedure is repeated by a different physician within the same group practice.
8. 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 the patient requires an unplanned return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon is required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- This modifier indicates that a minimum assistant surgeon was required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier when an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used when a non-physician provider assists in the surgery.
14. Modifier LT - Left Side
- Use this modifier to indicate that the procedure was performed on the left side of the body.
15. Modifier RT - Right Side
- Apply this modifier to indicate that the procedure was performed on the right side of the body.
Proper use of these modifiers ensures accurate billing and helps in avoiding claim denials or delays. Always refer to the latest coding guidelines and payer-specific requirements for the most accurate and up-to-date information.
Medicare reimbursement for CPT code 21110, which pertains to interdental fixation, depends on several factors including the specific circumstances of the procedure and the patient's medical necessity. Generally, Medicare Part B may cover this procedure if it is deemed medically necessary and is performed by a qualified healthcare provider. However, the reimbursement amount can vary based on geographic location, the setting of the service (e.g., hospital outpatient, physician's office), and other factors.
To determine the exact reimbursement amount for CPT code 21110, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS) or contact their local Medicare Administrative Contractor (MAC). The MPFS provides detailed information on the allowable charges for specific CPT codes, adjusted for geographic location and other variables.
For the most accurate and up-to-date information, it is advisable to consult the latest MPFS or use the Medicare Fee Schedule Lookup Tool available on the Centers for Medicare & Medicaid Services (CMS) website.
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 21110 for interdental fixation. Ensure you're receiving the full reimbursement you deserve from each payer. Schedule a demo today to see RevFind in action and safeguard your revenue.
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