CPT code 21336 is for the open treatment of a nasal septal fracture, with or without stabilization.
CPT code 21336 is for the open treatment of a nasal septal fracture, with or without stabilization. This means that the procedure involves surgically accessing the nasal septum to repair a fracture, and it may include additional steps to stabilize the septum if necessary.
For CPT code 21336 (Open treatment of nasal septal fracture, with or without stabilization), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work 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 used to indicate that the treatment was bilateral.
3. Modifier 51 - Multiple Procedures: If multiple procedures were performed during the same surgical session, this modifier should be used to indicate that 21336 was one of several procedures.
4. Modifier 52 - Reduced Services: If the procedure was partially reduced or eliminated at the physician's discretion, this modifier should be used.
5. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that the procedure was 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 needs to repeat the procedure, this modifier should be used.
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: If an unrelated procedure is performed by the same physician during the postoperative period, this modifier should be used.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon was necessary for the procedure, this modifier should be used.
11. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon was required.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): If an assistant surgeon was necessary due to the unavailability of a qualified resident surgeon, this modifier should be used.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Use this modifier if a non-physician provider assisted in the surgery.
These modifiers help provide additional information about the circumstances of the procedure and ensure accurate billing and reimbursement.
Medicare reimbursement for CPT code 21336, which refers to the open treatment of a septal fracture with or without stabilization, depends on several factors, including the specific Medicare Administrative Contractor (MAC) region, the setting in which the procedure is performed (e.g., hospital outpatient, inpatient, or ambulatory surgical center), and the patient's specific Medicare plan.
As of the latest available data, Medicare does reimburse for CPT code 21336. However, the reimbursement amount can vary. For instance, in a hospital outpatient setting, the reimbursement might be different compared to an inpatient setting or an ambulatory surgical center.
To obtain the most accurate and current reimbursement amount, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS) or contact their local MAC. Additionally, tools like the CMS Physician Fee Schedule Look-Up Tool can provide specific reimbursement rates based on geographic location and other factors.
For a precise figure, it is advisable to consult the latest MPFS or reach out to your local MAC, as reimbursement rates are subject to change and can be influenced by various factors such as geographic adjustments and policy updates.
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 21336 for open treatment of septal fractures. Ensure you're receiving accurate reimbursements from every payer. Schedule a demo today to see how RevFind can optimize your revenue cycle management.
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