CPT code 21142 is a medical billing code for a Lefort I-2 piece procedure without a graft.
CPT code 21142 is for a surgical procedure known as a LeFort I osteotomy, specifically a two-piece LeFort I osteotomy without the use of a bone graft. This procedure involves surgically cutting and repositioning the upper jaw (maxilla) into two segments to correct alignment and improve function, but it does not include the addition of any bone graft material.
When billing for CPT code 21142 (LeFort I, two-piece, without bone graft), 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 21142, 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. This could be due to factors such as increased complexity or unusual patient anatomy.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed bilaterally. This indicates that the same procedure was performed on both sides of the body.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session. This helps to indicate that more than one procedure was carried out.
4. Modifier 52 - Reduced Services
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion. It indicates that the service provided was less than usually required.
5. Modifier 53 - Discontinued Procedure
- Apply this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is particularly useful when billing for procedures that are not typically reported together.
7. Modifier 62 - Two Surgeons
- This modifier is used when two surgeons work together as primary surgeons performing distinct parts of the procedure. Each surgeon should report their distinct operative work.
8. Modifier 66 - Surgical Team
- Apply this modifier when a complex procedure requires the services of a surgical team. This indicates that multiple surgeons were involved in the procedure.
9. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same physician needs to repeat the procedure on the same day. This helps to clarify that the repeat procedure was necessary.
10. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used when a procedure is repeated by a different physician on the same day. It indicates that the repeat procedure was performed by another provider.
11. Modifier 78 - Unplanned Return to the Operating Room
- Apply this modifier if the patient requires 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 when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
13. 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 the primary surgeon.
14. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier when an assistant surgeon is required for a minimal portion of the procedure.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier 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
- This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
By appropriately applying these modifiers, healthcare providers can ensure accurate billing and optimize reimbursement for the services rendered.
Medicare reimbursement for CPT code 21142, which pertains to a Lefort I-2 piece procedure without graft, can vary based on several factors including the specific Medicare Administrative Contractor (MAC) jurisdiction, the setting in which the procedure is performed (e.g., inpatient vs. outpatient), and whether the procedure is deemed medically necessary.
As of the latest available data, Medicare does reimburse for CPT code 21142, but the exact reimbursement amount can fluctuate. Typically, the reimbursement rates are updated annually and can be found in the Medicare Physician Fee Schedule (MPFS). For precise and current reimbursement amounts, healthcare providers should refer to the MPFS or contact their local MAC.
To ensure accurate billing and optimal reimbursement, it is crucial to verify the medical necessity of the procedure and ensure proper documentation. Additionally, providers should stay updated with any changes in Medicare policies or fee schedules that may affect reimbursement rates for CPT code 21142.
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 21142 for Lefort i-2 piece without graft. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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