CPT code 21330 is for the open treatment of a nasal fracture with skeletal fixation.
CPT code 21330 is for the open treatment of a nasal bone fracture, which includes the use of skeletal fixation. This means that the procedure involves surgically exposing the fracture site and using hardware, such as plates or screws, to stabilize the broken bones in the nose.
For CPT code 21330, which refers to the open treatment of a nasal fracture with skeletal fixation, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort than typically required. Documentation must support the substantial additional work.
2. Modifier 51 - Multiple Procedures
- Apply this modifier when multiple procedures are performed during the same surgical session. This helps indicate that more than one procedure was carried out.
3. Modifier 52 - Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion. This indicates that the full service described by the CPT code was not performed.
4. Modifier 59 - Distinct Procedural Service
- This modifier is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances. It indicates that the service was distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the same procedure was repeated by the same physician. This indicates that the procedure was necessary to be performed more than once.
6. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if the procedure was repeated by a different physician. This helps to clarify that the repeat procedure was necessary and performed by another provider.
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 needs to 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 if an unrelated procedure is performed by the same physician during the postoperative period of the initial surgery.
9. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was necessary for the procedure. This indicates that another surgeon assisted in the operation.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon was not available.
11. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Apply this modifier when a non-physician provider assists in the surgery. This indicates the involvement of a PA, NP, or CNS in the procedure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Medicare does provide reimbursement for CPT code 21330, which refers to the open treatment of a nasal fracture with skeletal fixation. The reimbursement amount can vary based on several factors, including geographic location, the specific Medicare Administrative Contractor (MAC) overseeing the claim, and whether the procedure is performed in a facility or non-facility setting.
As of the latest available data, the national average reimbursement rate for CPT code 21330 under the Medicare Physician Fee Schedule (MPFS) is approximately $1,200. However, this amount is subject to change and should be verified with the current year's MPFS and the specific MAC guidelines.
For the most accurate and up-to-date reimbursement information, healthcare providers should consult the Medicare Physician Fee Schedule Lookup Tool or contact their local MAC.
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 21330 for open treatment of nasal fractures with skeletal fixation. Schedule a demo today to see how RevFind can ensure you're receiving accurate payments from every payer.
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