CPT code 21339 is for the surgical repair of an open nasoethmoid fracture with fixation.
CPT code 21339 is for a surgical procedure that involves the open treatment of a nasoethmoid fracture with fixation. This means that a surgeon makes an incision to access and repair a broken bone in the nasal and ethmoid regions, using hardware like plates or screws to stabilize the fracture.
For CPT code 21339 (Open treatment of nasoethmoid complex fracture with internal fixation), 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 the complexity of the fracture or patient-specific factors.
2. Modifier 51 - Multiple Procedures: If multiple procedures were performed during the same surgical session, this modifier should be appended to indicate that more than one procedure was carried out.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if a subsequent procedure is planned or staged and is related to the initial surgery.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure or Service by Same Physician: If the same procedure needs to be repeated by the same physician, this modifier should be used.
6. Modifier 77 - Repeat Procedure by Another Physician: If the procedure is repeated by a different physician, this modifier should be appended.
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: Use this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier should be used.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier if an assistant surgeon is necessary and a qualified resident surgeon is not available.
11. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: This modifier is used 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. Always refer to the latest CPT and payer guidelines for the most current information.
Medicare reimbursement for CPT code 21339, which refers to the open treatment of a nasoethmoid fracture with fixation, depends on several factors including the setting of the procedure (inpatient vs. outpatient), the specific Medicare Administrative Contractor (MAC) jurisdiction, and whether the procedure is deemed medically necessary.
Generally, Medicare Part B may cover this procedure if it is performed in an outpatient setting and is medically necessary. The reimbursement amount can vary, but as of the latest available data, the national average payment for CPT code 21339 in an outpatient setting is approximately $1,200. However, this amount can fluctuate based on geographic location and other factors.
For the most accurate and up-to-date information, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) or contact their local MAC.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and identify underpayments down to the CPT code level, including specific codes like 21339 for open nasoethmoid fracture with fixation. Schedule a demo today to see how RevFind can ensure you receive the full reimbursement you deserve from each payer.
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