CPT code 21335 is for the open treatment of a nasal and septal fracture.
CPT code 21335 is for the open treatment of a nasal and septal fracture. This means that a surgeon performs a procedure to repair a broken nose and the septum (the cartilage and bone that separates the two nostrils) through an open surgical approach, rather than a closed or minimally invasive method.
For CPT code 21335 (Open treatment of nasal and septal fracture), 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. This could be due to complications or unusual circumstances.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the nose, this modifier should be appended to indicate a bilateral procedure.
3. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier should be used to indicate that more than one procedure was performed.
4. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same physician needs to repeat the procedure, this modifier should be used.
7. Modifier 77 - Repeat Procedure by Another Physician: If a different physician repeats the procedure, this modifier should be appended.
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: Use this modifier if the patient needs 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: This modifier is used if an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier should be used.
11. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon is required.
12. 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 is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Use this modifier when these non-physician practitioners assist in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
Medicare does reimburse for CPT code 21335, which pertains to the open treatment of nasal and septal fractures. 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 21335 is approximately $1,200. However, it is essential to verify the exact reimbursement rate through the Medicare Physician Fee Schedule (MPFS) or your local Medicare Administrative Contractor (MAC) for the most accurate and up-to-date information.
Discover how MD Clarity's RevFind software can read your contracts and detect underpayments with pinpoint accuracy. With RevFind, you can identify discrepancies down to the CPT code level, such as CPT 21335 for open treatment of nose and septal fractures, and by individual payer. Schedule a demo today to see how RevFind can ensure you receive the full reimbursement you deserve.
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