CPT code 21345 is for the closed treatment of a nasal or jaw fracture, indicating a non-surgical procedure to fix the broken bones.
CPT code 21345 is for the closed treatment of a nasal or jaw fracture without manipulation. This means that the healthcare provider treats the broken nose or jaw without needing to physically adjust or realign the bones.
For CPT code 21345 (Closed treatment of nasal or jaw fracture), the following modifiers may be applicable depending on the specific circumstances of the treatment:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the work required to treat the fracture was substantially greater than typically required. Documentation must support the additional effort.
2. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: Use this modifier if an unrelated E/M service is performed during the postoperative period of the fracture treatment.
3. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: Use this modifier if a significant, separately identifiable E/M service is provided on the same day as the fracture treatment.
4. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure was performed on both sides of the body.
5. Modifier 51 - Multiple Procedures: Use this modifier if multiple procedures were performed during the same session.
6. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
7. Modifier 54 - Surgical Care Only: Use this modifier if the physician provided only the surgical care and not the preoperative or postoperative management.
8. Modifier 55 - Postoperative Management Only: Use this modifier if the physician provided only the postoperative management.
9. Modifier 56 - Preoperative Management Only: Use this modifier if the physician provided only the preoperative management.
10. 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.
11. Modifier 76 - Repeat Procedure or Service by Same Physician: Use this modifier if the same procedure was repeated by the same physician.
12. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the same procedure was repeated by a different physician.
13. 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 an unplanned return to the operating room for a related procedure during the postoperative period.
14. 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.
15. Modifier 80 - Assistant Surgeon: Use this modifier if an assistant surgeon was required during the procedure.
16. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon was required.
17. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.
18. Modifier 99 - Multiple Modifiers: Use this modifier if more than four modifiers are necessary to describe the service.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always ensure that the use of modifiers is supported by appropriate documentation in the patient's medical record.
When it comes to the reimbursement of CPT code 21345 (Closed treatment of nasal or jaw fracture) by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) for the most accurate and up-to-date information. Generally, Medicare does reimburse for medically necessary procedures, including the closed treatment of nasal or jaw fractures, provided that the treatment meets Medicare's coverage criteria.
As of the latest update, the reimbursement amount for CPT code 21345 can vary based on several factors, including geographic location, the setting in which the service is provided (e.g., hospital outpatient department, physician's office), and any applicable modifiers. For precise reimbursement rates, healthcare providers should refer to the MPFS or use the Medicare Fee Schedule Lookup Tool available on the Centers for Medicare & Medicaid Services (CMS) website.
To summarize, CPT code 21345 is typically reimbursed by Medicare, but the exact amount can vary. Providers should verify the current reimbursement rate through the appropriate Medicare resources to ensure accurate billing and reimbursement.
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