CPT code 21247 is for the surgical procedure to reconstruct the lower jaw bone.
CPT code 21247 is used for the surgical procedure to reconstruct the lower jaw bone. This code is typically used when a patient requires rebuilding or repairing the mandible due to trauma, disease, or congenital defects. The procedure involves using grafts, implants, or other surgical techniques to restore the structure and function of the lower jaw.
When billing for CPT code 21247 (Reconstruct lower jaw bone), 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 21247, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort or complexity than typically required.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the reconstruction is performed on both sides of the lower jaw.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services
- Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure
- Use 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
- Apply this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
7. Modifier 62 - Two Surgeons
- Use this modifier if two surgeons were required to perform the procedure together, each acting as a primary surgeon.
8. Modifier 66 - Surgical Team
- Apply this modifier if the procedure required a surgical team due to its complexity.
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
- Apply this modifier if a different physician performed the procedure more than once on the same day.
11. Modifier 78 - Unplanned Return to the Operating Room
- Use this modifier if the patient required 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
- Apply this modifier if the procedure was unrelated to the original surgery and performed during the postoperative period.
13. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was necessary for the procedure.
14. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon was required.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Apply this modifier if a non-physician provider assisted in the surgery.
Each modifier serves a specific purpose and should be used accurately to reflect the circumstances of the procedure. Proper use of these modifiers can help ensure that claims are processed correctly and that the healthcare provider receives appropriate reimbursement.
Medicare reimbursement for CPT code 21247, which pertains to the reconstruction of the lower jaw bone, depends on several factors including the specific circumstances of the procedure, the patient's medical necessity, and the setting in which the service is provided. Generally, Medicare does cover medically necessary reconstructive surgeries, including those involving the lower jaw bone, if they are deemed essential for the patient's health and well-being.
However, the exact reimbursement amount can vary based on the Medicare fee schedule, geographic location, and whether the procedure is performed in an inpatient or outpatient setting. For precise reimbursement rates, healthcare providers should refer to the current Medicare Physician Fee Schedule (MPFS) or contact their Medicare Administrative Contractor (MAC).
To ensure accurate billing and reimbursement, it is crucial to document the medical necessity of the procedure thoroughly and verify coverage specifics with Medicare prior to performing the surgery.
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 21247 for reconstructing the lower jaw bone. 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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