CPT code 21325 is for the open treatment of an uncomplicated nose fracture.
CPT code 21325 is used for the open treatment of an uncomplicated nasal fracture. This means that a healthcare provider performs surgery to realign and stabilize a broken nose without any additional complications.
For CPT code 21325 (Open treatment of nasal fracture; uncomplicated), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required. This could apply if the nasal fracture treatment was more complex than usual.
2. Modifier 50 - Bilateral Procedure: Used if the procedure was performed on both sides of the nose.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: Used when the service provided is less than the usual service described by the CPT code.
5. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: Used if the same procedure was repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician: Used if the same procedure was repeated by a different physician.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used if the patient had to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used if an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon: Used if an assistant surgeon was required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used if a minimum assistant surgeon was required.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used if an assistant surgeon was required because a qualified resident surgeon was not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used if a non-physician provider assisted in the surgery.
These modifiers should be used as appropriate to accurately reflect the specifics of the procedure performed and to ensure proper reimbursement. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
Medicare does reimburse for CPT code 21325, which pertains to the open treatment of an uncomplicated nasal fracture. The reimbursement amount can vary based on several factors, including geographic location and the specific Medicare Administrative Contractor (MAC) policies. As of the latest available data, the national average reimbursement for CPT code 21325 is approximately $1,200. However, it is essential to verify the exact reimbursement rate with your local MAC and consider any updates to Medicare's fee schedule.
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 21325 for open treatment of an uncomplicated nose fracture. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
