CPT code 21139 is a medical billing code used to describe the procedure for the reduction of the forehead.
CPT code 21139 is for the surgical procedure involving the reduction of the forehead. This typically includes reshaping or reducing the size of the forehead bone to achieve a desired aesthetic or functional outcome.
For CPT code 21139 (Reduction of forehead), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services
- Used when the work required to perform the procedure is substantially greater than typically required. This could be due to complications or additional work that was not anticipated.
2. Modifier 50 - Bilateral Procedure
- Applied if the procedure is performed on both sides of the body. For example, if the reduction of the forehead involves bilateral symmetry adjustments.
3. Modifier 51 - Multiple Procedures
- Used when multiple procedures are performed during the same surgical session. This modifier indicates that more than one procedure was performed and helps in the correct allocation of reimbursement.
4. Modifier 52 - Reduced Services
- Applied when the procedure is partially reduced or eliminated at the physician's discretion. This could be due to patient-specific factors or intraoperative findings.
5. Modifier 53 - Discontinued Procedure
- Used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service
- Indicates that a procedure or service was distinct or independent from other services performed on the same day. This is used to avoid bundling issues and to ensure proper reimbursement.
7. Modifier 62 - Two Surgeons
- Applied when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
8. Modifier 66 - Surgical Team
- Used when a complex procedure requires the services of several physicians, often of different specialties, working together as a team.
9. Modifier 76 - Repeat Procedure by Same Physician
- Used when the same procedure is repeated by the same physician subsequent to the original procedure.
10. Modifier 77 - Repeat Procedure by Another Physician
- Applied when the same procedure is repeated by a different physician subsequent to the original procedure.
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
- Used when a patient requires a return to the operating room for a related procedure during the postoperative period of the initial surgery.
12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Applied when a procedure or service performed during the postoperative period is unrelated to the original procedure.
13. Modifier 80 - Assistant Surgeon
- Used when an assistant surgeon is required to help with the procedure.
14. Modifier 81 - Minimum Assistant Surgeon
- Applied when a minimum assistant surgeon is required for the procedure.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Applied when these non-physician practitioners assist in the surgery.
These modifiers help in providing additional information about the procedure and ensure accurate 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 typically does not reimburse for cosmetic procedures, and CPT code 21139, which pertains to the reduction of the forehead, generally falls under this category. Cosmetic procedures are usually considered elective and not medically necessary, thus not covered by Medicare. However, if the procedure is deemed medically necessary due to a congenital defect, trauma, or other medical conditions, there might be exceptions.
To determine the exact reimbursement status and amount, it is essential to consult the Medicare Physician Fee Schedule (MPFS) or contact your Medicare Administrative Contractor (MAC). As of the latest updates, there is no standard reimbursement amount listed for CPT code 21139 under Medicare, reinforcing its classification as a non-covered service in most scenarios.
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 21139 for the reduction of the forehead. Ensure you're receiving the full reimbursement you deserve from every payer. Schedule a demo today to see RevFind in action and protect your revenue.
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