CPT code 21141 is for a Lefort I-1 piece procedure without a graft, used for billing and documentation in healthcare services.
CPT code 21141 is for a surgical procedure known as a LeFort I osteotomy, which involves a single-piece reconstruction of the upper jaw (maxilla) without the use of a bone graft. This procedure is typically performed to correct jaw deformities or misalignments.
For CPT code 21141 (Lefort I-1 piece without graft), 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 complications or unexpected findings.
2. Modifier 51 - Multiple Procedures
- Apply this modifier when multiple procedures are performed during the same surgical session. This indicates that more than one procedure was carried out.
3. 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. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
4. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same procedure is repeated by the same physician on the same day. This indicates that the procedure was necessary to be performed again.
5. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used when the same procedure is repeated by a different physician on the same day. It signifies that the procedure was necessary to be performed again by another provider.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Apply this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
8. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required to help with the procedure. It indicates that another surgeon assisted in the operation.
9. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier when a minimum assistant surgeon is required for the procedure. This indicates that assistance was minimal but necessary.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier when an assistant surgeon is required because a qualified resident surgeon was not available.
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.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Medicare reimbursement for CPT code 21141, which pertains to a Lefort I-1 piece procedure without graft, depends on several factors including the specific Medicare plan, the setting in which the procedure is performed, and whether the procedure is deemed medically necessary. Generally, Medicare Part B may cover this procedure if it is performed in an outpatient setting and is considered medically necessary by the treating physician. However, the reimbursement amount can vary.
As of the latest available data, the national average reimbursement rate for CPT code 21141 under Medicare Part B is approximately $1,200. This amount can fluctuate based on geographic location and other factors. It is advisable to check the most current Medicare Physician Fee Schedule (MPFS) or consult with your Medicare Administrative Contractor (MAC) for the most accurate and up-to-date reimbursement information.
For precise and personalized information, healthcare providers should verify coverage and reimbursement specifics directly with Medicare or through their billing department.
Discover how MD Clarity's RevFind software can meticulously read your contracts and detect underpayments down to the CPT code level, including specific codes like 21141 for Lefort i-1 piece without graft, and by individual payer. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.
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