CPT code 21485 is for resetting a dislocated jaw, detailing the specific medical procedure for accurate billing and documentation.
CPT code 21485 is for the medical procedure to reset a dislocated jaw. This involves a healthcare professional manually or surgically repositioning the jaw back into its proper alignment.
For CPT code 21485 (Reset dislocated jaw), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required. This could apply if the dislocation is particularly complex or requires additional time and effort.
2. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: Used if an evaluation and management service is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
3. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: Used if a significant, separately identifiable evaluation and management service is provided by the same physician on the same day as the procedure.
4. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.
5. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
6. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
7. Modifier 53 - Discontinued Procedure: Used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
8. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
9. Modifier 76 - Repeat Procedure or Service by Same Physician: Used if the same procedure is repeated by the same physician.
10. Modifier 77 - Repeat Procedure by Another Physician: Used if the same procedure is repeated by a different physician.
11. 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 if the patient requires a return to the operating room for a related procedure during the postoperative period.
12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used if an unrelated procedure is performed by the same physician during the postoperative period of another procedure.
13. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
14. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required because a qualified resident surgeon is not available.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in the surgery.
These modifiers help provide additional information about the circumstances of the procedure and ensure accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific requirements.
Medicare typically reimburses for CPT code 21485, which pertains to the resetting of a dislocated jaw. However, the exact reimbursement amount can vary based on several factors, including the geographic location of the healthcare provider, the specific Medicare plan, and whether the procedure is performed in an inpatient or outpatient setting. To obtain the precise reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS) or consult with their Medicare Administrative Contractor (MAC). It is also advisable to verify coverage and reimbursement details through the Medicare Coverage Database or directly with Medicare to ensure accurate billing and compliance.
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