CPT code 21615 is for the surgical removal of a rib.
CPT code 21615 is for the surgical procedure involving the removal of a rib. This code is used by healthcare providers to document and bill for the specific service of excising a rib, typically due to conditions such as infections, tumors, or trauma that necessitate its removal.
When billing for CPT code 21615 (Removal of rib), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and to provide additional information about the procedure. Below is a list of modifiers that could be used with CPT code 21615, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the removal of the rib required significantly more work than typically required. This could be due to factors such as increased complexity or time.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both sides of the body during the same operative session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures, including the removal of the rib, are performed during the same surgical session. This helps indicate that more than one procedure was conducted.
4. Modifier 59 - Distinct Procedural Service
- This modifier is used to indicate that the removal of the rib was a distinct procedural service from other services performed on the same day. It is particularly useful when the procedures are not typically reported together but are appropriate under the circumstances.
5. Modifier 62 - Two Surgeons
- Apply this modifier if two surgeons were required to perform the procedure together, each acting as a primary surgeon for a distinct part of the surgery.
6. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the removal of the rib was repeated by the same physician on the same day or during the postoperative period.
7. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used if the removal of the rib was repeated by a different physician on the same day or during the postoperative period.
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
- 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 the removal of the rib was performed during the postoperative period of another procedure but is unrelated to the initial surgery.
10. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required to help with the removal of the rib.
11. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon was required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier when an assistant surgeon is necessary because a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used when a non-physician provider assists in the surgery.
By appropriately applying these modifiers, healthcare providers can ensure accurate billing and reimbursement for the removal of a rib under CPT code 21615.
Medicare does reimburse for the CPT code 21615, which pertains to the removal of a rib. The reimbursement amount can vary based on several factors, including geographic location, the setting in which the procedure is performed (e.g., hospital outpatient department, ambulatory surgical center), and any applicable adjustments such as those for teaching hospitals or rural areas. As of the most recent data, the national average reimbursement rate for CPT code 21615 is approximately $1,200 to $1,500. However, it is essential to verify the exact reimbursement rate through the Medicare Physician Fee Schedule (MPFS) or the specific 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 identify underpayments with precision. With the ability to detect discrepancies down to the CPT code level, including specific codes like 21615 for the removal of a rib, RevFind ensures you receive the full reimbursement you deserve from each payer. Schedule a demo today to see how RevFind can optimize your revenue cycle and enhance your financial performance.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
