CPT code 21490 is a medical code used to describe the procedure for repairing a dislocated jaw.
CPT code 21490 is for the surgical procedure to repair a dislocated jaw. This involves repositioning the jaw back into its proper alignment and may include the use of wires, screws, or other devices to stabilize the jaw and ensure proper healing.
When billing for CPT code 21490 (Repair dislocated jaw), it is important to consider the use of appropriate modifiers to ensure accurate reimbursement and to provide additional information about the procedure. Below is a list of potential modifiers that could be used with CPT code 21490, 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
- Use this modifier if the repair of a dislocated jaw was performed bilaterally.
3. Modifier 51 - Multiple Procedures
- Use this modifier if multiple procedures were performed during the same surgical session.
4. Modifier 52 - Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure
- Use this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. 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.
7. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same physician repeated the procedure on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if a different physician repeated the procedure on the same day.
9. 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 required an unplanned return to the operating room for a related procedure during the postoperative period.
10. 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.
11. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon was required during the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted in the surgery.
15. Modifier LT - Left Side
- Use this modifier if the procedure was performed on the left side of the jaw.
16. Modifier RT - Right Side
- Use this modifier if the procedure was performed on the right side of the jaw.
By appropriately applying these modifiers, healthcare providers can ensure that their claims accurately reflect the services provided, which can lead to more efficient processing and appropriate reimbursement.
Medicare does provide reimbursement for CPT code 21490, which pertains to the repair of a dislocated jaw. However, the specific reimbursement amount can vary based on several factors, including geographic location, the setting in which the service is provided (e.g., hospital outpatient, inpatient, or physician's office), and any applicable modifiers that might affect payment.
To obtain the exact reimbursement amount for CPT code 21490, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS) or use the Medicare Administrative Contractor (MAC) lookup tools. These resources provide detailed and up-to-date information on reimbursement rates, which are subject to periodic adjustments.
For the most accurate and current reimbursement information, it is advisable to consult the latest MPFS or contact your local MAC directly.
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