CPT code 21210 is a medical code used to describe a surgical procedure for a face bone graft.
CPT code 21210 is for a surgical procedure where a bone graft is taken from one part of the body and transplanted to the bones of the face. This is typically done to repair or reconstruct facial bones that may have been damaged due to injury, disease, or congenital defects.
For CPT code 21210 (Face bone graft), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier when the work required to perform the procedure is substantially greater than typically required. This could be due to complications or other factors that increase the complexity of the procedure.
2. Modifier 51 - Multiple Procedures
- Apply this modifier when multiple procedures are performed during the same surgical session. This helps indicate that the face bone graft is one of several procedures conducted.
3. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the face bone graft is a distinct service from other procedures performed on the same day. This is particularly useful when the procedures are not typically reported together but are appropriate under the circumstances.
4. 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.
5. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the same physician needs to repeat the face bone graft procedure on the same day or during the postoperative period.
6. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier when a different physician repeats the face bone graft procedure on the same day or during the postoperative period.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- This modifier is used when the patient requires an unplanned return to the operating room for a related procedure during the postoperative period of the initial surgery.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier when the face bone graft is performed during the postoperative period of another, unrelated procedure.
9. Modifier 80 - Assistant Surgeon
- Use this modifier when an assistant surgeon is required to help perform the face bone graft procedure.
10. Modifier 81 - Minimum Assistant Surgeon
- This modifier is used when an assistant surgeon provides minimal assistance during the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier when an assistant surgeon is necessary because a qualified resident surgeon is not available.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier when a non-physician provider assists in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement for the face bone graft procedure.
Medicare reimbursement for CPT code 21210, which pertains to a face bone graft, depends on several factors including the medical necessity of the procedure, the setting in which it is performed, and the specific Medicare plan in question. Generally, Medicare Part B may cover this procedure if it is deemed medically necessary and is performed in an outpatient setting. However, the exact reimbursement amount can vary based on geographic location and other variables.
To determine the specific reimbursement amount for CPT code 21210, healthcare providers can refer to the Medicare Physician Fee Schedule (MPFS) or use the Medicare Administrative Contractor (MAC) lookup tools. These resources provide detailed information on allowable charges and can help in estimating the reimbursement amount. For the most accurate and up-to-date information, it is advisable to consult these tools directly or contact your local MAC.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and identify underpayments down to the CPT code level, including specific codes like 21210 for face bone grafts. Ensure you're receiving the full reimbursement you deserve from each payer. Schedule a demo today to see RevFind in action and protect your revenue.
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