CPT code 21445 is for treating a dental ridge fracture.
CPT code 21445 is used for the treatment of a dental ridge fracture. This involves medical procedures to repair or manage fractures in the bony ridge that supports the teeth, ensuring proper alignment and function.
When billing for CPT code 21445, which is used for treating a dental ridge fracture, it is essential to consider the appropriate modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of potential modifiers that could be used with CPT code 21445, along with the reasons for their use:
1. Modifier 22 (Increased Procedural Services):
- Use this modifier if the procedure required significantly greater effort or complexity than typically required.
2. Modifier 50 (Bilateral Procedure):
- Apply this modifier if the procedure was performed on both sides of the dental ridge.
3. Modifier 51 (Multiple Procedures):
- Use this modifier when multiple procedures are performed during the same surgical session.
4. Modifier 52 (Reduced Services):
- Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 59 (Distinct Procedural Service):
- Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
6. Modifier 76 (Repeat Procedure by Same Physician):
- Apply this modifier if the same procedure was repeated by the same physician on the same day.
7. Modifier 77 (Repeat Procedure by Another Physician):
- Use this modifier if the procedure was repeated by a different physician on the same day.
8. Modifier 78 (Unplanned Return to the Operating/Procedure Room):
- Apply this modifier if the patient had 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 if an unrelated procedure was performed by the same physician during the postoperative period.
10. Modifier 80 (Assistant Surgeon):
- Apply this modifier if an assistant surgeon was required during the procedure.
11. Modifier 81 (Minimum Assistant Surgeon):
- Use this modifier if a minimum assistant surgeon was required during the procedure.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)):
- Apply this modifier if an assistant surgeon was necessary because a qualified resident surgeon was not available.
13. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery):
- Use this modifier if a non-physician provider assisted in the surgery.
14. Modifier LT (Left Side):
- Apply this modifier if the procedure was performed on the left side of the dental ridge.
15. Modifier RT (Right Side):
- Use this modifier if the procedure was performed on the right side of the dental ridge.
16. Modifier GC (Service Performed in Part by a Resident Under the Direction of a Teaching Physician):
- Apply this modifier if the service was performed in part by a resident under the supervision of a teaching physician.
By appropriately applying these modifiers, healthcare providers can ensure accurate coding, billing, and reimbursement for the treatment of dental ridge fractures.
Medicare typically does not cover dental procedures, including the treatment of dental ridge fractures, as outlined by CPT code 21445. This is because Medicare Part A and Part B generally exclude routine dental care and procedures related to the teeth. However, there may be exceptions if the dental procedure is deemed medically necessary as part of a covered service, such as in the case of jaw reconstruction following an accident. For specific reimbursement amounts, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) or contact their Medicare Administrative Contractor (MAC) for the most accurate and up-to-date information.
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 21445 for treating dental ridge fractures. Schedule a demo today to see how RevFind can help you recover every dollar you're owed from each payer.
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