CPT code 21348 is for the open treatment of a nasomaxillary fracture with graft.
CPT code 21348 is for the open treatment of a nasomaxillary fracture with the use of a graft. This means that a surgeon performs a procedure to repair a broken bone in the nasal and maxillary (upper jaw) area, and during this procedure, they use a graft to help with the reconstruction and healing of the fracture.
For CPT code 21348 (Open treatment of nasomaxillary complex fracture with bone graft), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort than typically required. Documentation must support the substantial additional work.
2. Modifier 51 - Multiple Procedures
- Apply this modifier when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
3. Modifier 52 - Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion. Documentation should explain the reason for the reduction.
4. Modifier 59 - Distinct Procedural Service
- This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
5. 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.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Use this modifier if the same procedure is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- This modifier is used when a procedure is repeated by a different physician or other qualified healthcare professional.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period
- Apply this modifier if the patient requires a return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
- Use this modifier for procedures or services performed by the same physician during the postoperative period that are unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier when an assistant surgeon is required for a minimal portion of the procedure.
12. 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.
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 surgery.
Each modifier serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies. Proper use of modifiers ensures accurate billing and reimbursement for the services provided.
Medicare reimbursement for CPT code 21348, which pertains to the open treatment of a nasomaxillary complex fracture with graft, depends on several factors including the specific Medicare Administrative Contractor (MAC) jurisdiction, the setting in which the procedure is performed (e.g., inpatient hospital, outpatient hospital, or ambulatory surgical center), and the patient's specific Medicare plan.
As of the latest available data, Medicare does reimburse for CPT code 21348. However, the reimbursement amount can vary. For instance, in an outpatient setting, the national average reimbursement rate for this procedure might be around $1,500 to $2,000. It's crucial to verify the exact reimbursement rate with the local MAC, as rates can differ based on geographic location and other variables.
Healthcare providers should also ensure that all necessary documentation and coding guidelines are meticulously followed to avoid claim denials or delays in reimbursement. For the most accurate and up-to-date information, consulting the Medicare Physician Fee Schedule (MPFS) or contacting the local MAC is recommended.
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