CPT code 21360 is for the open treatment of a depressed malar fracture, which involves surgical intervention to repair the cheekbone.
CPT code 21360 is for the open treatment of a depressed malar (cheekbone) fracture. This means that a surgeon performs a procedure to fix a broken cheekbone by making an incision to access and repair the bone.
For CPT code 21360 (Open treatment of depressed malar fracture), 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 other factors that increase the complexity of the procedure.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session. This modifier indicates 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.
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 often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
5. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, each surgeon should report their distinct operative work by adding this modifier.
6. Modifier 76 - Repeat Procedure or Service by Same Physician: Used when a procedure or service is repeated by the same physician subsequent to the original procedure or service.
7. Modifier 77 - Repeat Procedure by Another Physician: Applied when a procedure or service is repeated by another physician subsequent to the original procedure or service.
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: Used when a related procedure is performed during the postoperative period of the initial procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Indicates that a procedure or service performed during the postoperative period was unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Indicates that a minimum assistant surgeon was required during the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary and a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Applied when these non-physician practitioners assist in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Medicare reimbursement for CPT code 21360, which refers to the open treatment of a depressed malar fracture, depends on several factors including the specific Medicare Administrative Contractor (MAC) jurisdiction, the setting in which the procedure is performed, and the patient's specific Medicare plan.
Generally, CPT code 21360 is reimbursable by Medicare when deemed medically necessary. The reimbursement amount can vary based on geographic location and other factors. As of the latest available data, the national average reimbursement rate for CPT code 21360 under the Medicare Physician Fee Schedule (MPFS) is approximately $1,200. However, this amount can fluctuate, so it is advisable to consult the latest MPFS or your local MAC for the most accurate and up-to-date reimbursement information.
For precise details, healthcare providers should verify the specific reimbursement rates through the Medicare Fee Schedule Lookup Tool or contact their local MAC. Additionally, ensuring proper documentation and justification for the procedure is crucial for successful 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 21360 for open treatment of depressed malar 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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