CPT code 21346 is for the open treatment of a nasomaxillary fracture with fixation.
CPT code 21346 is for the open treatment of a nasomaxillary fracture with fixation. This means that a surgeon will make an incision to access and repair a broken bone in the nasal and maxillary (upper jaw) area, using hardware like plates or screws to hold the bones in place as they heal.
For CPT code 21346 (Open treatment of nasomaxillary complex fracture, includes internal fixation, when performed), the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Used when the work required to provide a service is substantially greater than typically required. This could be due to complications or unusual circumstances during the procedure.
2. Modifier 51 (Multiple Procedures): Applied when multiple procedures are performed during the same surgical session. This helps indicate that the procedure is one of several performed.
3. Modifier 52 (Reduced Services): Used when a service or procedure is partially reduced or eliminated at the physician's discretion. This might be applicable if the full extent of the procedure was not necessary.
4. Modifier 59 (Distinct Procedural Service): Indicates that a procedure or service was distinct or independent from other services performed on the same day. This is used to avoid bundling issues and to clarify that the procedures were separate.
5. Modifier 76 (Repeat Procedure by Same Physician): Used when the same procedure is repeated by the same physician. This could be relevant if the patient requires additional treatment for the same fracture.
6. Modifier 77 (Repeat Procedure by Another Physician): Applied when the same procedure is repeated by a different physician. This might occur if the patient is transferred to another provider for further treatment.
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): Used when a 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): Indicates that a procedure performed during the postoperative period was unrelated to the original procedure.
9. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required for the procedure. This modifier helps indicate the involvement of an additional surgeon.
10. Modifier 81 (Minimum Assistant Surgeon): Applied when a minimum assistant surgeon is required for the procedure, indicating limited but necessary assistance.
11. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
12. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Indicates that a non-physician provider assisted in the surgery.
Each of these modifiers serves a specific purpose and helps provide a clearer picture of the services rendered, ensuring accurate billing and reimbursement.
Medicare reimbursement for CPT code 21346, which refers to the open treatment of a nasomaxillary complex fracture with fixation, depends on several factors including the setting of the procedure (inpatient vs. outpatient), the specific Medicare Administrative Contractor (MAC) jurisdiction, and the patient's individual Medicare plan.
Generally, Medicare Part B covers medically necessary surgical procedures performed by physicians, including those involving the treatment of fractures. However, the exact reimbursement amount can vary. For instance, in an outpatient setting, the reimbursement is determined by the Medicare Physician Fee Schedule (MPFS), while inpatient procedures are reimbursed under the Inpatient Prospective Payment System (IPPS).
As of the latest available data, the national average reimbursement for CPT code 21346 under the MPFS is approximately $1,200. However, this amount can fluctuate based on geographic location and other factors. For precise reimbursement rates, healthcare providers should consult the latest MPFS or contact their local MAC.
It's important to verify the specific details with the latest Medicare guidelines and fee schedules to ensure accurate billing and reimbursement.
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 21346 for open treatment of nasomaxillary fracture with fixation. Ensure you're receiving the full reimbursement you deserve from every payer. Schedule a demo today to see RevFind in action and safeguard your revenue.
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