CPT code 21199 is for reconstructing the lower jaw with advancement.
CPT code 21199 is used for the surgical procedure that involves reconstructing the lower jaw (mandible) with advancement. This means that the surgeon will reshape and reposition the lower jaw to correct deformities or misalignments, often to improve function or appearance.
When billing for CPT code 21199 (Reconstruction of lower jaw with advancement), several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort than typically required. This could be due to complications or unusual circumstances during the surgery.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the reconstruction was performed on both sides of the jaw.
3. Modifier 51 - Multiple Procedures
- Use this modifier if multiple procedures were performed during the same surgical session. This helps indicate that more than one distinct procedure was carried out.
4. Modifier 52 - Reduced Services
- This modifier is used if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure
- Apply this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threatened the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
7. Modifier 62 - Two Surgeons
- This modifier is used when two surgeons work together as primary surgeons performing distinct parts of the procedure.
8. Modifier 66 - Surgical Team
- Apply this modifier if the procedure required the services of a surgical team.
9. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same physician performed the procedure more than once on the same day.
10. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used if a different physician performed the procedure more than once on the same day.
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
- Apply this modifier if the patient had to 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 if an unrelated procedure was performed by the same physician during the postoperative period.
13. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required for the procedure.
14. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon was required for the procedure.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon was necessary because a qualified resident surgeon was 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.
Each of these modifiers provides additional information that can affect reimbursement and ensure accurate billing for the services rendered. Always refer to the latest coding guidelines and payer-specific policies to determine the appropriate use of modifiers.
Medicare reimbursement for CPT code 21199, which pertains to the reconstruction of the lower jaw with advancement, is contingent upon several factors including medical necessity, the setting in which the procedure is performed, and the specific Medicare Administrative Contractor (MAC) policies in your region.
As of the latest available data, Medicare does reimburse for CPT code 21199 when the procedure is deemed medically necessary. The reimbursement amount can vary based on geographic location and the specific details of the case. For instance, the Medicare Physician Fee Schedule (MPFS) provides a national average reimbursement rate, but this rate is adjusted by the Geographic Practice Cost Index (GPCI) to account for regional cost variations.
To obtain the most accurate and current reimbursement amount for CPT code 21199, healthcare providers should refer to the MPFS and check with their local MAC. Additionally, it is advisable to verify coverage criteria and documentation requirements to ensure compliance and optimize reimbursement.
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 21199 for reconstructing the lower jaw with advancement. 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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