CPT code 21155 is for a surgical procedure combining Lefort III and Lefort I osteotomies, often used to correct facial skeletal deformities.
CPT code 21155 is for a surgical procedure that involves performing a LeFort III osteotomy in conjunction with a LeFort I osteotomy. This complex surgery is typically done to correct severe facial deformities or injuries by repositioning the bones of the midface and upper jaw.
When billing for CPT code 21155 (LeFort III with LeFort I), 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 21155, 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 the patient's condition or the complexity of the surgery.
2. Modifier 50 - Bilateral Procedure
- If the procedure was performed bilaterally, this modifier should be appended to indicate that the surgery was done on both sides.
3. Modifier 51 - Multiple Procedures
- Apply this modifier if multiple procedures were 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. This indicates that the full service described by the CPT code was not performed.
5. 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 particularly useful when billing for multiple procedures that are not typically reported together.
6. Modifier 62 - Two Surgeons
- If two surgeons were required to perform the procedure, this modifier should be used to indicate that both surgeons had distinct responsibilities during the surgery.
7. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same physician performed the procedure more than once on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used if a different physician performed the same procedure on the same day.
9. 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 had to return to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if an unrelated procedure was performed by the same physician during the postoperative period of the initial procedure.
11. Modifier 80 - Assistant Surgeon
- This modifier should be used if an assistant surgeon was necessary for the procedure.
12. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon was required for the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier if an assistant surgeon was necessary because a qualified resident surgeon was not available.
14. 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 using these modifiers, healthcare providers can ensure accurate billing and maximize reimbursement for the services provided.
Medicare reimbursement for CPT code 21155, which pertains to Lefort III with Lefort I procedures, depends on several factors including the specific Medicare plan, the medical necessity of the procedure, and the setting in which the procedure is performed. Generally, Medicare Part B may cover medically necessary surgical procedures, but each case is subject to individual review.
To determine if CPT code 21155 is reimbursed by Medicare and the specific reimbursement amount, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) or use the Medicare Administrative Contractor (MAC) lookup tools. These resources provide detailed information on coverage and reimbursement rates, which can vary by geographic location and other factors.
For the most accurate and up-to-date information, it is advisable to contact the relevant MAC or refer to the latest MPFS data.
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