CPT code 21347 is for the open treatment of multiple nasomaxillary fractures.
CPT code 21347 is for the open treatment of multiple nasal and maxillary fractures. This involves surgically repairing fractures in both the nasal bones and the upper jaw (maxilla) through an open incision.
When billing for CPT code 21347 (Open treatment of nasomaxillary complex fracture(s), multiple), several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and the reasons for their use:
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 the complexity of the patient's condition.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both sides of the body.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session. This helps indicate that more than one procedure was carried out.
4. Modifier 52 - Reduced Services
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion.
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 76 - Repeat Procedure by Same Physician
- Use this modifier if the same procedure is repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used when the same procedure is repeated by a different physician.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Apply this modifier if the patient needs to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier when an assistant surgeon is necessary because a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used 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 accurately to ensure proper billing and reimbursement. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
Medicare reimbursement for CPT code 21347, which refers to the open treatment of nasomaxillary complex fractures (multiple), depends on several factors including the setting in which the procedure is performed (e.g., inpatient hospital, outpatient hospital, or physician's office) and the specific Medicare Administrative Contractor (MAC) jurisdiction.
As of the latest available data, Medicare does reimburse for CPT code 21347. However, the reimbursement amount can vary. For instance, in an outpatient setting, the national average reimbursement rate for this procedure might range from approximately $1,200 to $1,500. It's important to check the most current Medicare Physician Fee Schedule (MPFS) and consult with your local MAC for precise reimbursement rates applicable to your specific location and practice setting.
For the most accurate and up-to-date information, healthcare providers should refer to the Medicare Physician Fee Schedule Lookup Tool available on the Centers for Medicare & Medicaid Services (CMS) website 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 21347 for open treatment of nasomaxillary fractures. Ensure you're receiving the full reimbursement you deserve from every payer. Schedule a demo today to see RevFind in action and protect your revenue.
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