CPT code 21343 is for the open treatment of a depressed frontal sinus fracture.
CPT code 21343 is for the open treatment of a depressed frontal sinus fracture. This means that a surgeon performs an operation to correct a fracture in the frontal sinus area of the skull, where the bone has been pushed inward.
For CPT code 21343 (Open treatment of depressed frontal sinus fracture), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 51 - Multiple Procedures
- Apply this modifier when multiple procedures are performed during the same surgical session. This indicates that more than one procedure was carried out, which may affect reimbursement.
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 53 - Discontinued Procedure
- Apply this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 62 - Two Surgeons
- Apply this modifier when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure. Each surgeon should report their distinct operative work.
7. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same procedure is repeated by the same physician subsequent to the original procedure.
8. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if the same procedure is repeated by another physician subsequent to the original procedure.
9. 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 requires a return to the operating room for a related procedure during the postoperative period of the initial surgery.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if an unrelated procedure or service is performed by the same physician during the postoperative period of the initial procedure.
11. Modifier 80 - Assistant Surgeon
- Use this modifier when an assistant surgeon is required to assist the primary surgeon during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier when an assistant surgeon is required for a minimal portion of the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier when an assistant surgeon is required, and a qualified resident surgeon is not available.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Apply this modifier when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement for the services provided.
Medicare reimbursement for CPT code 21343, which refers to the open treatment of a depressed frontal sinus fracture, depends on several factors including the setting in which the procedure is performed (e.g., inpatient hospital, outpatient hospital, or ambulatory surgical center) and the specific Medicare Administrative Contractor (MAC) jurisdiction.
As of the latest available data, Medicare generally covers medically necessary surgical procedures, including the open treatment of a depressed frontal sinus fracture. However, the exact reimbursement amount can vary. For instance, in an outpatient setting, the reimbursement might be different compared to an inpatient setting due to the differing payment systems (OPPS vs. DRG).
To get a precise reimbursement amount, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS) or the Ambulatory Payment Classification (APC) rates for the specific year and locality. Additionally, consulting the local MAC can provide the most accurate and up-to-date information.
For example, in the 2023 MPFS, the national average reimbursement for CPT code 21343 in an outpatient setting might be approximately $1,500, but this figure can vary based on geographic adjustments and other factors.
Providers should always verify the current year's rates and any specific local adjustments to ensure accurate billing and reimbursement.
Discover how MD Clarity's RevFind software can meticulously read your contracts and detect underpayments down to the CPT code level and by individual payer. Ensure you're receiving accurate reimbursements for procedures like CPT code 21343 (Open treatment of depressed frontal sinus fracture). Schedule a demo today to see how RevFind can optimize your revenue cycle management.
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
