CPT code 21630 is for extensive sternum surgery, detailing the specific medical procedure for accurate billing and insurance purposes.
CPT code 21630 is for an extensive surgical procedure on the sternum, which is the bone located in the center of the chest. This code is used to document and bill for surgeries that involve significant work on the sternum, such as removing a large portion of the bone or repairing it after a major injury or disease.
For CPT code 21630, which pertains to extensive sternum surgery, 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 perform the procedure is substantially greater than typically required. This could be due to factors such as increased complexity or time.
2. Modifier 50 - Bilateral Procedure: Applied if the surgery is performed on both sides of the body during the same operative session.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session. This helps in indicating that the procedure is one of several performed.
4. Modifier 52 - Reduced Services: Applied when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Used when the procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. 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.
7. Modifier 62 - Two Surgeons: Applied when two surgeons work together as primary surgeons performing distinct parts of the procedure.
8. Modifier 66 - Surgical Team: Used when a team of surgeons is required to perform the procedure due to its complexity.
9. Modifier 76 - Repeat Procedure by Same Physician: Used when the same physician performs a procedure or service again on the same day.
10. Modifier 77 - Repeat Procedure by Another Physician: Applied when a procedure or service is repeated by another physician on the same day.
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 when the patient returns 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: Applied when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
13. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required to help with the procedure.
14. Modifier 81 - Minimum Assistant Surgeon: Applied when an assistant surgeon is required for a minimal portion of the procedure.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Applied when these non-physician practitioners assist in the surgery.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement for the extensive sternum surgery procedure.
Medicare reimbursement for CPT code 21630, which pertains to extensive sternum surgery, is contingent upon several factors, including medical necessity, the setting in which the procedure is performed, and the specific Medicare plan. Generally, Medicare Part B covers medically necessary surgical procedures, including extensive sternum surgeries, when performed in an outpatient setting, while Medicare Part A covers inpatient hospital stays.
To determine if CPT code 21630 is reimbursed by Medicare and the specific reimbursement amount, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS) or the Ambulatory Payment Classification (APC) for outpatient services. The reimbursement amount can vary based on geographic location and other factors. Providers can use the Medicare Administrative Contractor (MAC) websites or the CMS Physician Fee Schedule Look-Up Tool to find the exact reimbursement rates.
For the most accurate and up-to-date information, it is recommended to consult the latest MPFS or contact your local MAC.
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