CPT code 21497 is for interdental wiring, a procedure used to stabilize jaw fractures by wiring the teeth together.
CPT code 21497 is for interdental wiring, a procedure where wires are used to stabilize and align teeth, often following a jaw fracture or other dental trauma. This helps ensure proper healing and alignment of the teeth and jaw.
For CPT code 21497 (Interdental wiring), 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 greater effort or complexity than typically required.
2. Modifier 52 - Reduced Services
- Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
3. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the interdental wiring was performed as a separate and distinct service from other procedures performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician
- This modifier is used if the same physician needs to repeat the interdental wiring procedure within a short period.
5. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if another physician repeats the interdental wiring procedure within a short period.
6. 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 needs to return to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- This modifier is used if the interdental wiring is performed during the postoperative period of another procedure but is unrelated to the initial procedure.
8. Modifier 80 - Assistant Surgeon
- Apply this modifier if an assistant surgeon was required to help perform the interdental wiring.
9. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon was required for the procedure.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- This modifier is used if an assistant surgeon was necessary because a qualified resident surgeon was not available.
11. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Apply this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted in the surgery.
Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer policies to ensure accurate billing and reimbursement.
Medicare typically reimburses for CPT code 21497, which pertains to interdental wiring. However, the reimbursement amount can vary based on several factors, including the specific Medicare plan, geographic location, and the setting in which the service is provided. To obtain the most accurate and up-to-date reimbursement amount, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS) or contact their Medicare Administrative Contractor (MAC). It is also advisable to verify coverage and reimbursement specifics through the Medicare Coverage Database or directly with Medicare representatives.
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