CPT code 21310 is for the closed treatment of a nasal fracture without manipulation.
CPT code 21310 is for the closed treatment of a nasal bone fracture without manipulation. This means that the healthcare provider treats the broken nose without needing to physically adjust or realign the bones.
For CPT code 21310, which pertains to the closed treatment of a nasal fracture without manipulation, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as increased complexity or difficulty.
2. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: Use this modifier if an evaluation and management service was performed during the postoperative period of another procedure, and the service is unrelated to the original procedure.
3. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: Use this modifier if a significant, separately identifiable evaluation and management service is performed by the same physician on the same day as the procedure.
4. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure is performed on both sides of the body.
5. Modifier 51 - Multiple Procedures: Use this modifier if multiple procedures are performed during the same session.
6. Modifier 52 - Reduced Services: Use this modifier if the procedure is partially reduced or eliminated at the physician's discretion.
7. Modifier 57 - Decision for Surgery: Use this modifier if the evaluation and management service resulted in the initial decision to perform the surgery.
8. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day.
9. Modifier 76 - Repeat Procedure or Service by Same Physician: Use this modifier if the procedure is repeated by the same physician.
10. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the procedure is repeated by a different physician.
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: Use this modifier if the patient returns 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 or service is performed by the same physician during the postoperative period.
13. Modifier 80 - Assistant Surgeon: Use this modifier if an assistant surgeon is required during the procedure.
14. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon is required during the procedure.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier if an assistant surgeon is required and a qualified resident surgeon is not available.
16. Modifier 99 - Multiple Modifiers: Use this modifier if multiple modifiers are applicable to the procedure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Medicare does reimburse for CPT code 21310, which refers to the closed treatment of a nasal fracture without manipulation. The reimbursement amount can vary based on several factors, including geographic location and specific Medicare fee schedules. As of the latest available data, the national average reimbursement for CPT code 21310 is approximately $200. However, it is essential to verify the exact amount through the Medicare Physician Fee Schedule (MPFS) or consult with your Medicare Administrative Contractor (MAC) for the most accurate and up-to-date information.
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 21310 for closed treatment of nasal fractures without manipulation. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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