CPT code 21356 is for the open treatment of a depressed zygomatic arch, a procedure to correct facial bone fractures.
CPT code 21356 is for the open treatment of a depressed zygomatic arch. This procedure involves surgically correcting a fracture of the zygomatic arch, which is the bone that forms the prominence of the cheek. The "open treatment" indicates that the surgeon makes an incision to access and repair the bone.
When billing for CPT code 21356 (Open treatment of depressed zygomatic arch), 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 more work than typically required. This could be due to factors such as increased complexity or the patient's condition.
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 58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period): Use this modifier if the procedure was planned or staged during the postoperative period of another procedure.
4. Modifier 59 (Distinct Procedural Service): This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day. It helps to clarify that the services were not part of a bundled procedure.
5. Modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional): Use this modifier if the same procedure was repeated by the same provider.
6. Modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional): Apply this modifier if the procedure was repeated by a different provider.
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): Use this modifier if the patient had 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): This modifier is used if an unrelated procedure was performed by the same physician during the postoperative period of the initial procedure.
9. Modifier 80 (Assistant Surgeon): Apply this modifier if an assistant surgeon was necessary for the procedure.
10. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Use this modifier if an assistant surgeon was required because a qualified resident was not available.
11. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery): This modifier is used when a non-physician provider 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 21356, which refers to the open treatment of a depressed zygomatic arch, depends on several factors including the specific Medicare plan, the setting in which the procedure is performed, and the geographic location. Generally, Medicare Part B covers medically necessary surgical procedures, including those involving the treatment of facial fractures.
To determine if CPT code 21356 is reimbursed by Medicare and the specific reimbursement amount, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS) or the Medicare Administrative Contractor (MAC) for their region. These resources provide detailed information on covered services and the corresponding reimbursement rates.
As of the latest available data, the national average reimbursement rate for CPT code 21356 under Medicare Part B is approximately $1,200. However, this amount can vary based on local adjustments and specific circumstances. Providers are encouraged to verify the exact reimbursement rate through the MPFS or their MAC 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 21356 for open treatment of a depressed zygomatic arch. 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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