CPT code 21193 is for reconstructing the lower jaw without using a graft.
CPT code 21193 is for the reconstruction of the lower jaw without the use of a graft. This procedure involves surgically rebuilding or repairing the lower jawbone, but it does not include the addition of any graft material to aid in the reconstruction.
When billing for CPT code 21193 (Reconstruction of lower jaw without graft), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of potential modifiers that could be used with CPT code 21193, 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 time.
2. Modifier 50 (Bilateral Procedure):
- Apply this modifier if the procedure was performed on both sides of the body. This is relevant if the reconstruction involved both sides of the lower jaw.
3. Modifier 51 (Multiple Procedures):
- Use this modifier when multiple procedures are performed during the same surgical session. This helps indicate that 21193 was one of several procedures.
4. Modifier 52 (Reduced Services):
- This modifier is used if the procedure was partially reduced or eliminated at the physician's discretion. For example, if the reconstruction was less extensive than planned.
5. Modifier 59 (Distinct Procedural Service):
- Apply this modifier to indicate that the procedure was distinct or independent from other services performed on the same day. This is useful if 21193 was performed in conjunction with other procedures that are not typically reported together.
6. Modifier 62 (Two Surgeons):
- Use this modifier if two surgeons worked together as primary surgeons, each performing distinct parts of the procedure.
7. Modifier 76 (Repeat Procedure by Same Physician):
- This modifier is used if the same physician needs to repeat the procedure on the same day.
8. Modifier 77 (Repeat Procedure by Another Physician):
- Apply this modifier if a different physician repeats the procedure on the same day.
9. Modifier 78 (Unplanned Return to the Operating Room):
- Use this modifier if the patient needs 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):
- This modifier is used if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
11. Modifier 80 (Assistant Surgeon):
- Apply this modifier 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.
13. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)):
- This modifier is used 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):
- Apply this modifier if a non-physician practitioner assisted in the surgery.
By appropriately using these modifiers, healthcare providers can ensure that their claims for CPT code 21193 are accurately represented and reimbursed.
Medicare reimbursement for CPT code 21193, which pertains to the reconstruction of the lower jaw without a graft, 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 the geographic location, the setting in which the procedure is performed (e.g., hospital outpatient department, ambulatory surgical center), and other factors such as the Medicare Physician Fee Schedule (MPFS) and any applicable modifiers.
To determine the exact reimbursement amount for CPT code 21193, healthcare providers should refer to the latest MPFS or use the Medicare Administrative Contractor (MAC) lookup tools. These resources provide the most current and region-specific reimbursement rates.
For precise and up-to-date information, it is advisable to consult the Medicare Fee Schedule database or contact your local MAC.
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 21193 for lower jaw reconstruction without graft. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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