CPT code 21344 is for the open treatment of a complex fracture of the frontal sinus.
CPT code 21344 is for the open treatment of a complex fracture of the frontal sinus. This means that a surgeon performs an open surgical procedure to repair a complicated break in the frontal sinus, which is the air-filled cavity located behind the forehead.
When billing for CPT code 21344 (Open treatment of complicated frontal sinus fracture), the following modifiers may be applicable depending on the specific circumstances of the procedure:
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 51 - Multiple Procedures: Apply this modifier if multiple procedures were 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.
4. Modifier 53 - Discontinued Procedure: This modifier is used 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: Apply this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 62 - Two Surgeons: Use this modifier if two surgeons worked together as primary surgeons performing distinct parts of the procedure.
7. Modifier 66 - Surgical Team: This modifier is applicable if the procedure required the services of a surgical team.
8. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same physician performed the procedure more than once on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician: Apply this modifier if a different physician performed the procedure more than once on the same day.
10. 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 if the patient needs to return to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period.
12. Modifier 80 - Assistant Surgeon: Apply this modifier if an assistant surgeon was necessary for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon was required.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used if an assistant surgeon was necessary because a qualified resident surgeon was not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Apply this modifier if a non-physician practitioner assisted in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Medicare reimbursement for CPT code 21344, which refers to the open treatment of a complex frontal sinus fracture, depends on several factors including the setting in which the procedure is performed (e.g., hospital inpatient, outpatient, or ambulatory surgical center) and the specific Medicare Administrative Contractor (MAC) jurisdiction.
As of the latest available data, Medicare does reimburse for CPT code 21344. However, the reimbursement amount can vary. For instance, in a hospital outpatient setting, the payment might be different compared to an inpatient setting due to the distinct payment systems (OPPS vs. IPPS).
To provide a specific reimbursement amount, it is essential to refer to the Medicare Physician Fee Schedule (MPFS) or the relevant Ambulatory Payment Classification (APC) for the current year. As of the most recent update, the national average reimbursement for CPT code 21344 in an outpatient setting is approximately $1,500 to $2,000. However, this amount can vary based on geographic adjustments and other factors.
For the most accurate and up-to-date information, healthcare providers should consult the latest MPFS or contact their local MAC.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 21344 for open treatment of complex frontal sinus fractures. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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